Tania Villicana Gonzalez, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

315531 Issued in AZ

Practice address

PO Box 12716
San Luis, AZ 85349-6899

Phone

(928) 750-2019

NPI assigned

Jan 20, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sanando Integrative Med Clinic, PLLC

  • Family Medicine Physician
  • San Luis, AZ
  • NPI 1891450474
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1737331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737331200000",
    "number": "1053123802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12716",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "853496899",
            "telephone_number": "928-750-2019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 12716",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "853496899",
            "telephone_number": "928-750-2019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "TANIA",
        "middle_name": "VILLICANA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-20",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN191243",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "315531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bellezza Gonzalez
• Darlena Gonzalez, FNP-BC
• Marybel Rodriguez Gonzalez, NURSE PRACTITIONER
• Miguel Angel Gonzalez, ED.S
• Miriam Gonzalez, DMD
• Daniela Graciano, FNP
• Mario Guerrero, MD
• Sucharitha Gunasekera, M.D.
• Adrian Gutierrez, FNP-BC
• Christina Alyssa Gutierrez

• All providers in San Luis, AZ
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.