Healthcare Provider Details

I. General information

NPI: 1548188436
Provider Name (Legal Business Name): JOSELYNE ANNETH GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STERLING PLAZA DR STE 406
PONTE VEDRA FL
32081-8562
US

IV. Provider business mailing address

7816 SOUTHSIDE BLVD APT 179
JACKSONVILLE FL
32256-0478
US

V. Phone/Fax

Practice location:
  • Phone: 904-518-7134
  • Fax:
Mailing address:
  • Phone: 904-518-7134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL7477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: