Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MR. IBSEN FUNDORA GONZALEZ APRN
NPI 1396354627
Nurse Practitioner - Psychiatric/Mental Health in Miami, FL

Q: What is Ibsen Fundora Gonzalez's NPI number?

The NPI number for Ibsen Fundora Gonzalez is 1396354627. It was assigned to this individual provider in the NPPES registry on July 22, 2020.

Q: What is Ibsen Fundora Gonzalez's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Active since July 22, 2020PECOS Enrolled

10095 N KENDALL DR, MIAMI, FL 33176(786) 504-0904 Get Directions Write a Review

NPPES record last updated: August 11, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 11, 2026, Sep 18, 2020, Jul 23, 2020 (3 updates tracked since 2020).

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About Mr. Ibsen Fundora Gonzalez Aprn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. IBSEN FUNDORA GONZALEZ APRN (NPI 1396354627) is an individual psychiatric/mental health provider in Miami, Florida, licensed in Florida (APRN11008252) and active in the NPI registry since July 2020. He is enrolled in Medicare PECOS and maintains a secondary practice location in Pembroke Pines.

NPPES Registry Identity

NPI1396354627

Entity TypeIndividualMale

Primary Taxonomy363LP0808X

Provider Legal NameMR. IBSEN FUNDORA GONZALEZCredential: APRN

Location Address10095 N KENDALL DRMiami, FL 33176-1797

Mailing Address11270 Pines BlvdPembroke Pines, FL 33026-4101 · (561) 255-9330

Phone(786) 504-0904

Sole ProprietorYes

Enumeration DateJuly 22, 2020

Last NPPES UpdateAugust 11, 20263 updates tracked since enumeration

NPPES CertifiedAugust 11, 2026

✔ NPI 1396354627 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in FL · APRN11008252

Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License APRN11008252 (FL)

10095 N KENDALL DR, Miami, FL 33176

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Secondary Practice Location 1

Location 111270 Pines BlvdPembroke Pines, FL 33026-4101 · Phone (954) 628-5748

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Ibsen Fundora Gonzalez Aprn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33176 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$96.13 typical visit price

range $60.92 – $187.05

Typical copayment $24.03 (range $15.23 – $46.76)

Most-billed visit code 99203

Established Patient

$107.17 typical visit price

range $18.99 – $150.24

Typical copayment $26.79 (range $4.74 – $37.56)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. LESTER FREDERICK SHALLOWAY M.D.

Internal Medicine