Healthcare Provider Details

I. General information

NPI: 1124070016
Provider Name (Legal Business Name): JACQUELINE S GONZALEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 68TH ST
HIALEAH FL
33016-1801
US

IV. Provider business mailing address

450 SW 19TH RD
MIAMI FL
33129-1314
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-5000
  • Fax:
Mailing address:
  • Phone: 305-858-9816
  • Fax: 305-858-7116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberNP832422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: