MEDICARE: MARLEN GONZALEZ APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	ARNP9261363	FL
2	363LF0000X	Family Nurse Practitioner	APRN9261363	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215309141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLEN GONZALEZ APRN

Provider Business Mailing Address
First Line	:	6818 MITCHELL CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2938
Country	:	US
Telephone Number	:	813-506-4251
Fax Number	:	813-373-5683

Provider Business Practice Location Address
First Line	:	6101 WEBB RD STE 301
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2866
Country	:	US
Telephone Number	:	813-885-3600
Fax Number	:	813-885-4600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	06/18/2020

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Directions to “ MARLEN GONZALEZ APRN” Practice Location

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