Healthcare Provider Details

I. General information

NPI: 1396669099
Provider Name (Legal Business Name): NICOLE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 SW 20TH PL STE 201
OCALA FL
34471-6351
US

IV. Provider business mailing address

8084 SW 45TH CT
OCALA FL
34476-4595
US

V. Phone/Fax

Practice location:
  • Phone: 352-831-8090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: