Healthcare Provider Details

I. General information

NPI: 1124727656
Provider Name (Legal Business Name): ELIZA CARLINA GOMEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 SW 108TH PL
MIAMI FL
33173-1229
US

IV. Provider business mailing address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-970-2121
  • Fax: 305-585-8128
Mailing address:
  • Phone: 305-970-2121
  • Fax: 305-585-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11019932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: