Provider Demographics
NPI:1285381921
Name:IGNACIO, EMELIE GONZALES
Entity type:Individual
Prefix:
First Name:EMELIE
Middle Name:GONZALES
Last Name:IGNACIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BELLEAIR RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2241
Mailing Address - Country:US
Mailing Address - Phone:727-637-8454
Mailing Address - Fax:
Practice Address - Street 1:1330 BELLEAIR RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2241
Practice Address - Country:US
Practice Address - Phone:727-637-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9444728163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse