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General NPI Number Information
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NPI Number | 1477464469
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Entity Type | Individual
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Provider Name | LIDICE GONZALEZ GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 4180 SW 53RD AVE
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City | DAVIE
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State | FL
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Zip | 33314-3731
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Country | US
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Telephone | 786-382-7232
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 NW 12TH AVE
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City | MIAMI
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State | FL
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Zip | 33136-1003
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Country | US
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Telephone | 305-689-5808
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Fax | 305-689-1175
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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 | 11050991
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License Number State | FL
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