Provider Demographics
NPI:1730723990
Name:GOMEZ, MONICA (APRN)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 KINGS HIGHWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-8421
Mailing Address - Country:US
Mailing Address - Phone:941-613-1777
Mailing Address - Fax:941-613-1779
Practice Address - Street 1:4235 KINGS HIGHWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-8421
Practice Address - Country:US
Practice Address - Phone:941-613-1777
Practice Address - Fax:941-613-1779
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily