Healthcare Provider Details

I. General information

NPI: 1962140434
Provider Name (Legal Business Name): YOVANY GONGORA MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 NW 36TH ST STE 213
VIRGINIA GARDENS FL
33166-6973
US

IV. Provider business mailing address

11620 SW 185TH ST
MIAMI FL
33157-6518
US

V. Phone/Fax

Practice location:
  • Phone: 786-562-7479
  • Fax: 305-564-7610
Mailing address:
  • Phone: 786-660-1844
  • Fax: 305-564-7610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11019813
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-123140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: