Provider Demographics
NPI:1194354597
Name:GOMEZ, ERICA NICOLETTE (LVN)
Entity type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:NICOLETTE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BOCA CHICA BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7701
Mailing Address - Country:US
Mailing Address - Phone:956-312-3851
Mailing Address - Fax:
Practice Address - Street 1:401 BOCA CHICA BLVD APT 201
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7701
Practice Address - Country:US
Practice Address - Phone:956-312-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353065164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse