MEDICARE: FATIMA GONZALEZ RN

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	363L00000X	Nurse Practitioner	1-184710	AL
2	163W00000X	Registered Nurse	1-184710	AL

General Provider Information

NPI Number	:	1790472439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATIMA GONZALEZ RN

Provider Business Mailing Address
First Line	:	PO BOX 55310
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35255-5310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 19TH ST S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-1900
Country	:	US
Telephone Number	:	205-934-4011
Fax Number	:

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

Provider Enumeration Date	:	04/21/2023
Last Update Date	:	05/06/2026

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