Provider Demographics
NPI:1902257447
Name:GOMEZ-PRATT, GINA (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GOMEZ-PRATT
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 EXECUTIVE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-2260
Mailing Address - Country:US
Mailing Address - Phone:727-347-0005
Mailing Address - Fax:
Practice Address - Street 1:3001 EXECUTIVE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-2260
Practice Address - Country:US
Practice Address - Phone:727-347-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7225133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered