Healthcare Provider Details

I. General information

NPI: 1942135389
Provider Name (Legal Business Name): NORYS DE JESUS GONZALEZ FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12911 N TELECOM PKWY
TEMPLE TERRACE FL
33637-0907
US

IV. Provider business mailing address

12911 N TELECOM PKWY
TEMPLE TERRACE FL
33637-0907
US

V. Phone/Fax

Practice location:
  • Phone: 813-553-7880
  • Fax:
Mailing address:
  • Phone: 813-553-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-523347
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: