Provider Demographics
NPI:1538576186
Name:CLAYTON GOMEZ, JUDITH ANTOINETTE (ARNP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANTOINETTE
Last Name:CLAYTON GOMEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:ANTOINETTE
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:5201 SW 196TH LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1111
Mailing Address - Country:US
Mailing Address - Phone:954-648-0398
Mailing Address - Fax:305-964-0370
Practice Address - Street 1:5201 SW 196TH LN
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33332-1111
Practice Address - Country:US
Practice Address - Phone:954-648-0398
Practice Address - Fax:305-964-0370
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1089452363LA2200X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health