Provider Demographics
NPI:1215695572
Name:GOMEZ, JUANA ALEIDA (FNP)
Entity type:Individual
Prefix:
First Name:JUANA
Middle Name:ALEIDA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JUANA
Other - Middle Name:ALEIDA
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1010 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6654
Mailing Address - Country:US
Mailing Address - Phone:956-968-1621
Mailing Address - Fax:956-447-0646
Practice Address - Street 1:1010 JAMES ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6654
Practice Address - Country:US
Practice Address - Phone:956-968-1621
Practice Address - Fax:956-447-0646
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059072363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner