Provider Demographics
NPI:1598557480
Name:GOMES, LISA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GOMES
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 OKEECHOBEE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8707
Mailing Address - Country:US
Mailing Address - Phone:561-812-9497
Mailing Address - Fax:
Practice Address - Street 1:11440 OKEECHOBEE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8707
Practice Address - Country:US
Practice Address - Phone:561-812-9497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11037942363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health