Doctor Name: | CARRIE GONZALEZ |
NPI Number: | 1396161725 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 747268 |
Business Practice Address: | 2306 Ranch Road 620 S Lakeway, TX - 787346269 |
Business Phone Number: | 5122636000 |
Business Fax Number: | |
Mailing Address: | 22308 Moulin Dr, SPICEWOOD |
State: | TX |
Postal Code: | 786692330 |
Phone Number: | 5128882998 |
Fax Number: | |
NPI Enumeration Date: | 03/10/2014 |
NPI Last Update Date: | 02/21/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 747268 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |