=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962140434
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOVANY GONGORA MSN, APRN, FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2022
-----------------------------------------------------
Last Update Date | 08/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 NW 165TH ST STE 310
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-6342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-562-7479
-----------------------------------------------------
Fax | 305-564-7610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 540 NW 165TH ST STE 310
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-6342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-660-1844
-----------------------------------------------------
Fax | 305-564-7610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-20-123140
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11019813
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------