Healthcare Provider Details

I. General information

NPI: 1376205419
Provider Name (Legal Business Name): DIANA GABRIELA GONZALEZ MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 W POPLAR ST
ROGERS AR
72756-4245
US

IV. Provider business mailing address

614 E EMMA AVE STE 300
SPRINGDALE AR
72764-4469
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-9235
  • Fax: 479-631-0374
Mailing address:
  • Phone: 479-751-7417
  • Fax: 479-751-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number216275
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: