Healthcare Provider Details

I. General information

NPI: 1487386132
Provider Name (Legal Business Name): YANETT GONZALEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 TECHNOLOGICAL AVE STE 15
ORLANDO FL
32817-8353
US

IV. Provider business mailing address

3451 TECHNOLOGICAL AVE STE 15 ORLANDO, FL
ORLANDO FL
32817-8353
US

V. Phone/Fax

Practice location:
  • Phone: 407-821-3506
  • Fax: 407-831-3507
Mailing address:
  • Phone: 407-821-3506
  • Fax: 407-831-3507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11020321
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: