Healthcare Provider Details

I. General information

NPI: 1013706399
Provider Name (Legal Business Name): VANESSA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 NW 16TH PL
CAPE CORAL FL
33993-7113
US

IV. Provider business mailing address

429 NW 16TH PL
CAPE CORAL FL
33993-7113
US

V. Phone/Fax

Practice location:
  • Phone: 786-246-8675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11043603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: