Healthcare Provider Details

I. General information

NPI: 1548572506
Provider Name (Legal Business Name): DANEB GONZALEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 NW 110TH AVE STE 317
MIAMI FL
33172-1930
US

IV. Provider business mailing address

1695 NW 110TH AVE STE 317
MIAMI FL
33172-1930
US

V. Phone/Fax

Practice location:
  • Phone: 305-671-3654
  • Fax: 305-459-3242
Mailing address:
  • Phone: 305-671-3654
  • Fax: 305-459-3242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9191783
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: