Healthcare Provider Details

I. General information

NPI: 1578974002
Provider Name (Legal Business Name): AMY GONZALES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13670 WALSINGHAM RD
LARGO FL
33774-3532
US

IV. Provider business mailing address

PO BOX 10744
CLEARWATER FL
33757-8744
US

V. Phone/Fax

Practice location:
  • Phone: 727-593-9848
  • Fax: 727-596-4532
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-266-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT206885
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME132550
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: