Healthcare Provider Details

I. General information

NPI: 1568285682
Provider Name (Legal Business Name): JESSICA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2368 SW 168TH LOOP
OCALA FL
34473-4359
US

IV. Provider business mailing address

2368 SW 168TH LOOP
OCALA FL
34473-4359
US

V. Phone/Fax

Practice location:
  • Phone: 407-485-1990
  • Fax:
Mailing address:
  • Phone: 407-485-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberG0592009550201
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number445455
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberG0592009550201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: