Healthcare Provider Details

I. General information

NPI: 1386281194
Provider Name (Legal Business Name): CRISTINA JACINTA RODRIGUES GONCALVES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2019
Last Update Date: 04/03/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 TOWN CENTER BLVD
WESTON FL
33326-3636
US

IV. Provider business mailing address

1400 MEADOWS BLVD
WESTON FL
33327-1805
US

V. Phone/Fax

Practice location:
  • Phone: 954-507-4494
  • Fax:
Mailing address:
  • Phone: 954-397-5759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9620188
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number19-492
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11038463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: