Healthcare Provider Details

I. General information

NPI: 1215407671
Provider Name (Legal Business Name): MAYELIN GONZALEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W DR MARTIN LUTHER KING JR BLVD STE 800
TAMPA FL
33607-6065
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-873-0000
  • Fax: 813-873-3659
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11007930
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: