Healthcare Provider Details

I. General information

NPI: 1104404862
Provider Name (Legal Business Name): KRISTA GOMES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 09/17/2026
Certification Date: 03/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 N FEDERAL HWY
FORT LAUDERDALE FL
33308
US

IV. Provider business mailing address

10437 SW 53RD ST
COOPER CITY FL
33328-5607
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-8000
  • Fax:
Mailing address:
  • Phone: 954-594-4302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME163093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: