Healthcare Provider Details

I. General information

NPI: 1588511604
Provider Name (Legal Business Name): GABRIEL ALEX GOMEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7261 SHERIDAN ST STE 100B
HOLLYWOOD FL
33024-2708
US

IV. Provider business mailing address

7261 SHERIDAN ST STE 340
HOLLYWOOD FL
33024-2726
US

V. Phone/Fax

Practice location:
  • Phone: 954-561-6222
  • Fax: 954-990-7650
Mailing address:
  • Phone: 954-561-6222
  • Fax: 954-990-7650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11046117
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: