Provider Demographics
NPI:1730519554
Name:GONZALEZ, ANIDE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ANIDE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:ANIDE
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8655 22ND ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-1725
Mailing Address - Country:US
Mailing Address - Phone:772-774-8952
Mailing Address - Fax:772-774-8945
Practice Address - Street 1:8655 22ND ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1725
Practice Address - Country:US
Practice Address - Phone:772-774-8952
Practice Address - Fax:772-774-8945
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 2945502163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009315600Medicaid