MEDICARE: YANETT 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	363LF0000X	Family Nurse Practitioner	11020321	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	:	1487386132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANETT GONZALEZ APRN

Provider Business Mailing Address
First Line	:	3451 TECHNOLOGICAL AVE STE 15 ORLANDO, FL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-8353
Country	:	US
Telephone Number	:	407-821-3506
Fax Number	:	407-831-3507

Provider Business Practice Location Address
First Line	:	3451 TECHNOLOGICAL AVE
Second Line	:	STE 15
City	:	ORLANDO
State	:	FL
Zip	:	32817-8353
Country	:	US
Telephone Number	:	407-821-3506
Fax Number	:	407-831-3507

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

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	05/05/2026

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