MEDICARE: STACEY 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	363LA2100X	Acute Care Nurse Practitioner	11041688	FL

General Provider Information

NPI Number	:	1619716164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY GONZALEZ

Provider Business Mailing Address
First Line	:	3084 GROVE RD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2440
Country	:	US
Telephone Number	:	561-846-9275
Fax Number	:

Provider Business Practice Location Address
First Line	:	3084 GROVE RD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2440
Country	:	US
Telephone Number	:	561-846-9275
Fax Number	:

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

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	11/01/2025

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Directions to “ STACEY GONZALEZ ” Practice Location

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