Healthcare Provider Details

I. General information

NPI: 1912193202
Provider Name (Legal Business Name): GLORIA I GOMEZ AGNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 04/17/2022
Certification Date: 04/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 GULFGATE CENTER MALL
HOUSTON TX
77087-3023
US

IV. Provider business mailing address

PO BOX 616788
ORLANDO FL
32861-6788
US

V. Phone/Fax

Practice location:
  • Phone: 281-846-7209
  • Fax: 833-845-2871
Mailing address:
  • Phone: 407-447-7120
  • Fax: 407-770-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP135179
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: