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MS. JACKIE AGNESS GONZALEZ
NPI 1407670094
Nurse Practitioner - Psychiatric/Mental Health in Waldorf, MD

Active since November 11, 2024
4307 EAGLE TRACE CT, WALDORF, MD 20602(301) 351-7881 Get Directions Write a Review

NPPES record last updated: November 11, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ms. Jackie Agness Gonzalez NPPES

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

MS. JACKIE AGNESS GONZALEZ (NPI 1407670094) is an individual psychiatric/mental health provider in Waldorf, Maryland, licensed in Maryland (R131587) and active in the NPI registry since November 2024.

NPPES Registry Identity

NPI1407670094
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameMS. JACKIE AGNESS GONZALEZ
Location Address4307 EAGLE TRACE CTWaldorf, MD 20602-3116
Mailing Address4307 Eagle Trace CtWaldorf, MD 20602-3116 · (301) 351-7881
Phone(301) 351-7881
Sole ProprietorNo
Enumeration DateNovember 11, 2024
NPPES CertifiedNovember 11, 2024
✔ NPI 1407670094 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in MD · R131587
4307 EAGLE TRACE CT, Waldorf, MD 20602
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Other Names 1

Professional Name (2)Ms. Jackie Gonzalez

Other Providers at the Same Location NPPES

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

ZEAL MENTAL HEALTH & WELLNESS CENTER LLC
Nurse Practitioner (Psychiatric/Mental Health)
4307 EAGLE TRACE CT
WALDORF, MD 20602
Charles County (301) 818-3805

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackie Gonzalez's NPI number?

The NPI number for Jackie Gonzalez is 1407670094. It was assigned to this individual provider in the NPPES registry on November 11, 2024. The provider is also known as Ms. Jackie Gonzalez.

Where is Jackie Gonzalez located?

Jackie Gonzalez practices at 4307 Eagle Trace Ct, Waldorf, MD 20602. The listed phone number is (301) 351-7881.

What is Jackie Gonzalez's specialty?

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

When was this NPI record last updated?

The NPPES record for Jackie Gonzalez was last updated on November 11, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.