Healthcare Provider Details

I. General information

NPI: 1093684060
Provider Name (Legal Business Name): NANCY GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 803
FAJARDO PR
00738-0803
US

IV. Provider business mailing address

URBANIZACION MONTE BRISAS 2 CALLE U P1
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 787-435-8167
  • Fax:
Mailing address:
  • Phone: 787-435-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number71556
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: