Healthcare Provider Details

I. General information

NPI: 1710808274
Provider Name (Legal Business Name): JACOB EDWARD GONZALEZ DNP, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 GATTIS SCHOOL RD
ROUND ROCK TX
78664-7428
US

IV. Provider business mailing address

1855 GATTIS SCHOOL RD
ROUND ROCK TX
78664-7428
US

V. Phone/Fax

Practice location:
  • Phone: 512-238-6268
  • Fax:
Mailing address:
  • Phone: 512-238-6268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1045911
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: