=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003459025
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IVON GONZALEZ APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2019
-----------------------------------------------------
Last Update Date | 08/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13691 METRO PKWY STE 420
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33912-4349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-215-4064
-----------------------------------------------------
Fax | 239-215-4063
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2675 WINKLER AVE FL 2
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33901-9342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-215-4064
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11003429
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------