Healthcare Provider Details

I. General information

NPI: 1376210393
Provider Name (Legal Business Name): CARINA S GOMEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24830 BURNT PINE DR STE 3
BONITA SPRINGS FL
34134-1974
US

IV. Provider business mailing address

2915 27TH ST SW
LEHIGH ACRES FL
33976-4015
US

V. Phone/Fax

Practice location:
  • Phone: 239-823-3179
  • Fax: 239-268-9688
Mailing address:
  • Phone: 352-593-3976
  • Fax: 239-268-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11014016
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0104871-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: