Healthcare Provider Details

I. General information

NPI: 1710455795
Provider Name (Legal Business Name): ROCIO ISABEL GOMEZ-WOODY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 N CONNECTICUT AVE
ROYAL OAK MI
48067-2037
US

IV. Provider business mailing address

831 N CONNECTICUT AVE
ROYAL OAK MI
48067-2037
US

V. Phone/Fax

Practice location:
  • Phone: 702-981-5870
  • Fax:
Mailing address:
  • Phone: 702-981-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908009
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704397880
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: