Provider Demographics
NPI:1083316186
Name:GOMEZ TORRES, JUAN MANUEL (APRN)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:GOMEZ TORRES
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:M
Other - Last Name:GOMEZ TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:5825 W 25TH CT APT 102
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4463
Mailing Address - Country:US
Mailing Address - Phone:786-247-6625
Mailing Address - Fax:
Practice Address - Street 1:5825 W 25TH CT APT 102
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4463
Practice Address - Country:US
Practice Address - Phone:786-247-6625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022616363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner