Provider Demographics
NPI:1528527884
Name:GONZALEZ, BRIANNA LYNN
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LYNN
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 1:510 N ROME AVE UNIT 301
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1316
Mailing Address - Country:US
Mailing Address - Phone:561-312-3528
Mailing Address - Fax:407-395-3779
Practice Address - Street 1:1991 DANIELS RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4599
Practice Address - Country:US
Practice Address - Phone:407-395-3770
Practice Address - Fax:407-395-3779
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-17
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty