Healthcare Provider Details

I. General information

NPI: 1245944453
Provider Name (Legal Business Name): AMANDA LUISA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13340 METRO PKWY STE 400
FORT MYERS FL
33966-4818
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1105
  • Fax: 239-343-4259
Mailing address:
  • Phone: 239-343-1105
  • Fax: 239-343-4259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN1104332
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9527732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: