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NPI Code Detail

MEDICARE: NICHOLE GONZALEZ

MEDICARE: NICHOLE 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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

Other Identifiers

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

General Provider Information

NPI Number : 1972117398
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLE GONZALEZ
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PARKWAY, SUITE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-3625
Country : US
Telephone Number : 866-610-0580
Fax Number :
Provider Business Practice Location Address
First Line : 601 S LAKE DESTINY RD STE 350
Second Line :
City : MAITLAND
State : FL
Zip : 32751-7222
Country : US
Telephone Number : 407-618-0493
Fax Number : 855-864-1499
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2020
Last Update Date : 03/06/2023

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Directions to “ NICHOLE GONZALEZ ” Practice Location

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