Provider Demographics
NPI:1124254867
Name:GOMEZ, NANCY RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:RENEE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5036 SW 91ST TER
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3526
Mailing Address - Country:US
Mailing Address - Phone:773-339-4366
Mailing Address - Fax:
Practice Address - Street 1:1425 NW 62ND ST STE 201
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1916
Practice Address - Country:US
Practice Address - Phone:773-339-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11545111N00000X
OHDC-05313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1682669OtherBCBS