Ibsen Fundora Gonzalez, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN11008252 Issued in FL

Practice address

10095 N Kendall Dr
Miami, FL 33176-1797

Phone

(786) 504-0904

NPI assigned

Jul 22, 2020

Last updated

Aug 11, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Smart Health Solutions & Consulting, Inc.

  • Psychiatric/Mental Health Nurse Practitioner
  • Pembroke Pines, FL
  • NPI 1447186267
  Authorized official Same address or phone
• Consultants in Neurological Surgery LLP

  • Neurological Surgery Physician
  • Miami, FL
  • NPI 1336323500

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1595376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786406400000",
    "number": "1396354627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11270 PINES BLVD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330264101",
            "telephone_number": "561-255-9330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10095 N KENDALL DR",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331761797",
            "telephone_number": "786-504-0904"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11270 Pines Blvd",
            "address_purpose": "LOCATION",
            "city": "Pembroke Pines",
            "state": "FL",
            "postal_code": "330264101",
            "country_code": "US",
            "telephone_number": "954-628-5748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUNDORA GONZALEZ",
        "first_name": "IBSEN",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-22",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11008252",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11008252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jorge E Fundicher
• Maria Lilia Fundora Cabrera, DPM
• Yissel Fundora Cruz
• Claudia Rachel Fundora Gonzalez
• Diana Caridad Fundora Gonzalez
• Ivan Gabriel Fundora Gonzalez, MD
• Yaisel Fundora Gonzalez
• Fundora Holding Company Inc. (Global Medical)
• Lena Fundora Moreno
• Lilian Fundora Pelayo, DMD

• Psychiatric/Mental Health Nurse Practitioner in Miami, FL
• Providers in Miami, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; 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.