Provider Demographics
NPI:1063187128
Name:GONZALEZ-ROMAN, JOSE LUIS (APRN,FNP-C,PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:GONZALEZ-ROMAN
Suffix:
Gender:M
Credentials:APRN,FNP-C,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14888 SUMMER BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-5130
Mailing Address - Country:US
Mailing Address - Phone:813-502-9354
Mailing Address - Fax:
Practice Address - Street 1:14888 SUMMER BRANCH DR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-5130
Practice Address - Country:US
Practice Address - Phone:813-502-9354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012338363LF0000X, 363LP0808X
GAGAA-NP-000179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily