MEDICARE: SAHVANNAH 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	1181414	TX

General Provider Information

NPI Number	:	1780491944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAHVANNAH GONZALEZ APRN

Provider Business Mailing Address
First Line	:	1120 HERITAGE TRL
Second Line	:
City	:	NORTHLAKE
State	:	TX
Zip	:	76226-3252
Country	:	US
Telephone Number	:	972-746-9405
Fax Number	:	972-797-9224

Provider Business Practice Location Address
First Line	:	2960 LONG PRAIRIE RD
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4845
Country	:	US
Telephone Number	:	972-333-5760
Fax Number	:	972-797-9224

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

Provider Enumeration Date	:	12/11/2024
Last Update Date	:	12/11/2025

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