Healthcare Provider Details

I. General information

NPI: 1821492851
Provider Name (Legal Business Name): DARLENE NICKOL GONZALES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8705 ROBBY AVE SW
ALBUQUERQUE NM
87121-9007
US

IV. Provider business mailing address

8705 ROBBY AVE SW
ALBUQUERQUE NM
87121-9007
US

V. Phone/Fax

Practice location:
  • Phone: 505-270-4255
  • Fax:
Mailing address:
  • Phone: 505-270-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN-73898
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number79294
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-73898
License Number StateNM
# 7
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number79294
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: