Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 23584 | SC |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 23584 | SC |
NPI | 1881234631 |
---|---|
Provider Name | Patrisa Gonzalez |
First Address | Atlanta, GA 30374-3904 |
Second Address | Columbia, SC 29203-6864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2020 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP6638 | (05) | SC |