Provider Demographics
NPI:1588145932
Name:GONZALEZ, MAILEN (ARNP- FNP)
Entity type:Individual
Prefix:
First Name:MAILEN
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ARNP- FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12294 SW 29TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2224
Mailing Address - Country:US
Mailing Address - Phone:786-200-3564
Mailing Address - Fax:
Practice Address - Street 1:12294 SW 29 TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175
Practice Address - Country:US
Practice Address - Phone:786-200-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9245674363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner