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General NPI Number Information
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NPI Number | 1144522996
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Entity Type | Individual
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Provider Name | JESSICA ANNE GONZALEZ FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 06/10/2016
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Provider Practice Location Address
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Address Line | 200 MADISON AVE SUITE 2D
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City | ELMIRA
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State | NY
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Zip | 14901-3218
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Country | US
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Telephone | 607-733-4681
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Fax | 607-733-1729
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Provider Business Mailing Address
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Address Line | 571 SAINT JOSEPHS BLVD FL 2
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City | ELMIRA
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State | NY
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Zip | 14901-3230
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Country | US
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Telephone | 607-271-2050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F336277-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 336277
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License Number State | NY
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