Provider Demographics
NPI:1487307724
Name:GONZALEZ, JESSICA MILENA (NP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MILENA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PARKVIEW AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2810
Mailing Address - Country:US
Mailing Address - Phone:914-471-5947
Mailing Address - Fax:
Practice Address - Street 1:41 E POST RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4699
Practice Address - Country:US
Practice Address - Phone:914-681-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309968-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health