Provider Demographics
NPI:1447912100
Name:GONZALEZ-MARTINEZ, JOSE MANUEL (FNP-BC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MANUEL
Last Name:GONZALEZ-MARTINEZ
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 LEE TRACE DR
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-9519
Mailing Address - Country:US
Mailing Address - Phone:818-390-3071
Mailing Address - Fax:
Practice Address - Street 1:147 LEE TRACE DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-9519
Practice Address - Country:US
Practice Address - Phone:818-390-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCGONZ-UYV3E363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily