=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376297713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRG MEDICAL CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2022
-----------------------------------------------------
Last Update Date | 06/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1960 N JOHN YOUNG PKWY
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34741-3221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-402-7829
-----------------------------------------------------
Fax | 855-540-1852
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1960 N JOHN YOUNG PKWY
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34741-3221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-402-7829
-----------------------------------------------------
Fax | 855-540-1852
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JOALEXIS GONZALEZ FERNANDEZ
-----------------------------------------------------
Credential | APRN, FNP-C
-----------------------------------------------------
Telephone | 321-402-7829
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------