Healthcare Provider Details

I. General information

NPI: 1023982733
Provider Name (Legal Business Name): JOSE GONZALEZ-SOTO, PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14021 N DALE MABRY HWY
TAMPA FL
33618-2401
US

IV. Provider business mailing address

7402 N 56TH ST STE 355
TAMPA FL
33617-7700
US

V. Phone/Fax

Practice location:
  • Phone: 813-303-6871
  • Fax: 385-473-8371
Mailing address:
  • Phone: 813-303-6871
  • Fax: 385-473-8371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE G GONZALEZ-SOTO
Title or Position: ADDICTION & PSYCHIATRIC NP
Credential: DNP,PMHNP-BC,CARN-AP
Phone: 813-303-6871