MEDICARE: LIEN AFON GONZALEZ

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	11023029	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437868700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIEN AFON GONZALEZ

Provider Business Mailing Address
First Line	:	8406 QUARTZ PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4925
Country	:	US
Telephone Number	:	813-846-7590
Fax Number	:	813-939-8487

Provider Business Practice Location Address
First Line	:	8406 QUARTZ PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4925
Country	:	US
Telephone Number	:	813-846-7590
Fax Number	:	813-939-8487

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

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	01/27/2026

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Directions to “ LIEN AFON GONZALEZ ” Practice Location

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