Provider Demographics
NPI:1427282896
Name:GOMEZ, ANNE MARIE (MSN, FNP)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MARIE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:MRS
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:CARAVAJAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP
Mailing Address - Street 1:401 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2138
Mailing Address - Country:US
Mailing Address - Phone:719-545-3555
Mailing Address - Fax:719-545-1517
Practice Address - Street 1:401 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2138
Practice Address - Country:US
Practice Address - Phone:719-545-3555
Practice Address - Fax:719-545-1517
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92164363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner