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NPI Code Detail

MEDICARE: JENNIFER ANN GONZALEZ APRN, PMHNP

MEDICARE: JENNIFER ANN GONZALEZ APRN, PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner8053528-4405UT

General Provider Information

NPI Number : 1285519686
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANN GONZALEZ APRN, PMHNP
Provider Business Mailing Address
First Line : 1525 UNIVERSITY VLG
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-3523
Country : US
Telephone Number : 801-828-7903
Fax Number :
Provider Business Practice Location Address
First Line : 955 W 3300 S
Second Line :
City : SOUTH SALT LAKE
State : UT
Zip : 84119-3325
Country : US
Telephone Number : 801-583-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2025
Last Update Date : 03/11/2026

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