Individual
JESSICA L AMAYA GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ADULT/GERONTOLOGY NP
Contact information
Practice address
100 PORT WASHINGTON BLVD, ROSLYN, NY 11576-1353
(516) 562-6766
Mailing address
100 PORT WASHINGTON BLVD, ROSLYN, NY 11576-1353
(516) 562-6766
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F308225-1
NY
363LG0600X
Gerontology Nurse Practitioner
F308225-1
NY
Other
Enumeration date
12/29/2017
Last updated
04/01/2021
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