MEDICARE: BISLEIDY GONZALEZ

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	363LF0000X	Family Nurse Practitioner	APRN11016628	FL

General Provider Information

NPI Number	:	1437818366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BISLEIDY GONZALEZ

Provider Business Mailing Address
First Line	:	3801 NW 186TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2846
Country	:	US
Telephone Number	:	305-527-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 NW 186TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2846
Country	:	US
Telephone Number	:	305-527-0249
Fax Number	:

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

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	12/08/2021

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Directions to “ BISLEIDY GONZALEZ ” Practice Location

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