Healthcare Provider Details

I. General information

NPI: 1295692887
Provider Name (Legal Business Name): KIMBERLY GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SW 27TH AVE STE 609
MIAMI FL
33135-2968
US

IV. Provider business mailing address

23291 SW 113TH CT
HOMESTEAD FL
33032-7161
US

V. Phone/Fax

Practice location:
  • Phone: 305-723-9974
  • Fax:
Mailing address:
  • Phone: 787-231-7549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN11047438
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: