Healthcare Provider Details

I. General information

NPI: 1497272603
Provider Name (Legal Business Name): HERNAN JOSUE GONZALEZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 02/26/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16903 LAKESIDE DR STE 4D
MONTVERDE FL
34756-3241
US

IV. Provider business mailing address

588 BRANTLEY TERRACE WAY UNIT 205
ALTAMONTE SPRINGS FL
32714-0834
US

V. Phone/Fax

Practice location:
  • Phone: 407-426-4337
  • Fax:
Mailing address:
  • Phone: 407-795-2956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9418709
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: