1881823060 NPI number — MRS. DEANNA M HOWARD-GONZALEZ RD, LD, CDE

Table of content: MRS. DEANNA M HOWARD-GONZALEZ RD, LD, CDE (NPI 1881823060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881823060 NPI number — MRS. DEANNA M HOWARD-GONZALEZ RD, LD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWARD-GONZALEZ
Provider First Name:
DEANNA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LD, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOWARD
Provider Other First Name:
DEANNA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, LD, CDE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881823060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 MIRACLE STRIP PKWY SE UNIT 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WALTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32548-5976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-374-7604
Provider Business Mailing Address Fax Number:
850-792-2545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 MIRACLE STRIP PKWY SE UNIT 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WALTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32548-5976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-374-7604
Provider Business Practice Location Address Fax Number:
850-792-2545
Provider Enumeration Date:
07/08/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  ND3885 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ND3885 . This is a "FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".