Provider Demographics
NPI:1962393744
Name:GONZALEZ, HEIDI C (FNP-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:C
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 MCREE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2716
Mailing Address - Country:US
Mailing Address - Phone:229-251-4420
Mailing Address - Fax:
Practice Address - Street 1:2700 N OAK ST BLDG B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-5903
Practice Address - Country:US
Practice Address - Phone:229-249-8687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN121140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily