Healthcare Provider Details

I. General information

NPI: 1083394100
Provider Name (Legal Business Name): JILL GONZALEZ NELSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL ANN GONZALEZ

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BULLARD PKWY
TEMPLE TERRACE FL
33617-5510
US

IV. Provider business mailing address

2400 MAITLAND CENTER PKWY STE 310
MAITLAND FL
32751-7442
US

V. Phone/Fax

Practice location:
  • Phone: 813-988-5214
  • Fax:
Mailing address:
  • Phone: 352-329-1800
  • Fax: 352-329-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberAPRN11029653
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11029653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: