Provider Demographics
NPI:1861751026
Name:GOMEZ, IRENE (APRN)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:3564 89TH ST
Mailing Address - Street 2:APT 5C
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5766
Mailing Address - Country:US
Mailing Address - Phone:216-224-0798
Mailing Address - Fax:
Practice Address - Street 1:2624 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3609
Practice Address - Country:US
Practice Address - Phone:904-513-3240
Practice Address - Fax:904-398-7871
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2023-10-18
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028156363LP2300X
NY303828-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No164W00000XNursing Service ProvidersLicensed Practical Nurse