Provider Demographics
NPI:1366273955
Name:GONC, SOLVEG DOS SANTOS
Entity type:Individual
Prefix:
First Name:SOLVEG
Middle Name:DOS SANTOS
Last Name:GONC
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 1:2909 NOTTEL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-8767
Mailing Address - Country:US
Mailing Address - Phone:321-682-8699
Mailing Address - Fax:
Practice Address - Street 1:2909 NOTTEL DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-8767
Practice Address - Country:US
Practice Address - Phone:321-682-8699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174N00000X, 374J00000X
MA174N00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN