Healthcare Provider Details

I. General information

NPI: 1750205746
Provider Name (Legal Business Name): EVYS MANUEL GONZALEZ APRN, FNC-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 E 21ST ST APT 2
HIALEAH FL
33013-4047
US

IV. Provider business mailing address

539 E 21ST ST APT 2
HIALEAH FL
33013-4047
US

V. Phone/Fax

Practice location:
  • Phone: 786-237-9066
  • Fax:
Mailing address:
  • Phone: 786-237-9066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026058050
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: