Healthcare Provider Details

I. General information

NPI: 1407400559
Provider Name (Legal Business Name): SHELBY NICOLE GOMEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELBY NICOLE POTTS

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-4249
US

IV. Provider business mailing address

PO BOX 100247
GAINESVILLE FL
32610-0247
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0301
  • Fax:
Mailing address:
  • Phone: 352-273-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11004028
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9457625
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-142605
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: