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General NPI Number Information
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NPI Number | 1427441856
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Entity Type | Individual
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Provider Name | STEPHANIE KAY GONZALEZ FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 07/30/2022
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Provider Practice Location Address
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Address Line | 111 LAKE HOLLINGSWORTH DR
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City | LAKELAND
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State | FL
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Zip | 33801-5607
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Country | US
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Telephone | 863-687-1376
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Fax | 863-687-1377
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Provider Business Mailing Address
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Address Line | 10854 GORDEN SETTER DR
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City | OSCEOLA
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State | IN
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Zip | 46561-8538
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Country | US
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Telephone | 574-540-6349
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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 | 71005521A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN9480590
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License Number State | FL
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