Provider Demographics
NPI:1992729065
Name:GONZALEZ, CONNIE REMOLINA
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:REMOLINA
Last Name:GONZALEZ
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 1:19590 OLD CUTLER RD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8048
Mailing Address - Country:US
Mailing Address - Phone:186-466-3500
Mailing Address - Fax:
Practice Address - Street 1:19590 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8048
Practice Address - Country:US
Practice Address - Phone:786-466-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1428932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3032761-00Medicaid
FL20104OtherJMH ID #
FLS30681Medicare UPIN
FL3032761-00Medicaid