Healthcare Provider Details

I. General information

NPI: 1831818996
Provider Name (Legal Business Name): VICTORIA NICOLE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 1602
JACKSONVILLE FL
32216-6298
US

IV. Provider business mailing address

1844 N LAURA ST
JACKSONVILLE FL
32206-3662
US

V. Phone/Fax

Practice location:
  • Phone: 904-945-7556
  • Fax: 904-379-0113
Mailing address:
  • Phone: 561-706-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT23358
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: