Healthcare Provider Details

I. General information

NPI: 1003652090
Provider Name (Legal Business Name): JAVIER GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 W UNIVERSITY AVE
GAINESVILLE FL
32607-7609
US

IV. Provider business mailing address

7540 W UNIVERSITY AVE
GAINESVILLE FL
32607-7609
US

V. Phone/Fax

Practice location:
  • Phone: 352-647-9700
  • Fax:
Mailing address:
  • Phone: 352-647-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9119274
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: