MEDICARE: JESSICA GONZALES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A189926	IA

General Provider Information

NPI Number	:	1023941564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GONZALES

Provider Business Mailing Address
First Line	:	2219 W GEORGE WASHINGTON BLVD
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52804-1417
Country	:	US
Telephone Number	:	563-370-3994
Fax Number	:

Provider Business Practice Location Address
First Line	:	2219 W GEORGE WASHINGTON BLVD
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52804-1417
Country	:	US
Telephone Number	:	563-370-3994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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Directions to “ JESSICA GONZALES ” Practice Location

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