Healthcare Provider Details

I. General information

NPI: 1285643486
Provider Name (Legal Business Name): MABEL GONZALEZ NOVO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 01/31/2023
Certification Date: 05/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 N ARMENIA AVE
TAMPA FL
33603-1405
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 813-272-0420
  • Fax: 844-388-6186
Mailing address:
  • Phone: 800-480-5243
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME100923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: