Provider Demographics
NPI:1881418465
Name:GONZALES, ROXANNE MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:MARIE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 GOLDEN GATE PARK
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-2420
Mailing Address - Country:US
Mailing Address - Phone:210-316-2875
Mailing Address - Fax:
Practice Address - Street 1:2313 GOLDEN GATE PARK
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-2420
Practice Address - Country:US
Practice Address - Phone:210-316-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737894163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care