Provider Demographics
NPI:1225724669
Name:GONZALEZ, JESSICA LUCAS (MSN, CRNP, FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LUCAS
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LUCAS
Other - Last Name:ALTAMIRANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 MARTLING RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-7208
Mailing Address - Country:US
Mailing Address - Phone:256-585-5942
Mailing Address - Fax:
Practice Address - Street 1:15239 AL HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35962-3481
Practice Address - Country:US
Practice Address - Phone:256-925-0012
Practice Address - Fax:256-925-0016
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-180962363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse