Healthcare Provider Details

I. General information

NPI: 1710607338
Provider Name (Legal Business Name): ANGELICA REBECA GOMEZ CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

1801 ATLANTIC AVE FL 3
ATLANTIC CITY NJ
08401-6804
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-4000
  • Fax:
Mailing address:
  • Phone: 856-537-0287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01359500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: