Healthcare Provider Details

I. General information

NPI: 1558779942
Provider Name (Legal Business Name): NEIL GOMEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9981 S HEALTHPARK DR
FORT MYERS FL
33908-3618
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-0258
  • Fax: 239-343-0973
Mailing address:
  • Phone: 239-343-0258
  • Fax: 239-343-0973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN9259674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: