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: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W BIG BEAVER RD STE 600
TROY MI
48084-5209
US

IV. Provider business mailing address

100 W BIG BEAVER RD STE 600
TROY MI
48084-5209
US

V. Phone/Fax

Practice location:
  • Phone: 855-322-4077
  • Fax:
Mailing address:
  • Phone: 855-322-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: