Provider Demographics
NPI:1427441856
Name:GONZALEZ, STEPHANIE KAY (FNP-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:KAY
Other - Last Name:DUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:10854 GORDEN SETTER DR
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-8538
Mailing Address - Country:US
Mailing Address - Phone:574-540-6349
Mailing Address - Fax:
Practice Address - Street 1:111 LAKE HOLLINGSWORTH DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5607
Practice Address - Country:US
Practice Address - Phone:863-687-1376
Practice Address - Fax:863-687-1377
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005521A363LF0000X
FLAPRN9480590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily