=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083283410
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN LEONARD GONCALO FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2021
-----------------------------------------------------
Last Update Date | 02/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 WILKENS DR
-----------------------------------------------------
City | PLAINVILLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02762-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-225-6035
-----------------------------------------------------
Fax | 833-428-4981
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 HIMES ST
-----------------------------------------------------
City | NORTH KINGSTOWN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02852-4717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-365-8966
-----------------------------------------------------
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 | 2339801
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------