Individual
MA TERESITA GONZALES DE JESUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2290 CRESCENT MOON ST, KISSIMMEE, FL 34746-2315
(305) 778-3537
Mailing address
2290 CRESCENT MOON ST, KISSIMMEE, FL 34746-2315
(305) 778-3537
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
11003968
FL
363LG0600X
Gerontology Nurse Practitioner
11003968
FL
Other
Enumeration date
09/06/2019
Last updated
09/06/2019
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