Provider Demographics
NPI:1215309141
Name:GONZALEZ, MARLEN (APRN)
Entity type:Individual
Prefix:
First Name:MARLEN
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6818 MITCHELL CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2938
Mailing Address - Country:US
Mailing Address - Phone:813-506-4251
Mailing Address - Fax:813-373-5683
Practice Address - Street 1:6101 WEBB RD STE 301
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2866
Practice Address - Country:US
Practice Address - Phone:813-885-3600
Practice Address - Fax:813-885-4600
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9261363363LA2200X
FLAPRN9261363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health