Provider Demographics
NPI:1528714342
Name:GONZALES, TAINA MARIA (RN)
Entity type:Individual
Prefix:
First Name:TAINA
Middle Name:MARIA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 NEWBOLD AVE APT 707
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-5025
Mailing Address - Country:US
Mailing Address - Phone:718-600-4647
Mailing Address - Fax:
Practice Address - Street 1:1966 NEWBOLD AVE APT 707
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-5025
Practice Address - Country:US
Practice Address - Phone:718-600-4647
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
NY624218163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool