Provider Demographics
NPI:1225834484
Name:GONZALEZ, EDDIE (ARNP)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 NW ALMOND LOOP
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277
Mailing Address - Country:US
Mailing Address - Phone:360-672-1525
Mailing Address - Fax:
Practice Address - Street 1:435 SW SEDGWICK RD STE 101
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6433
Practice Address - Country:US
Practice Address - Phone:360-672-1525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61633227363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health