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General NPI Number Information
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NPI Number | 1013503762
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Entity Type | Individual
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Provider Name | AMADA LIGIA GOMEZ NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 1989 CITRINE WAY
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City | SANTA ROSA
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State | CA
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Zip | 95404-7012
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Country | US
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Telephone | 786-385-4492
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Fax |
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Provider Business Mailing Address
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Address Line | 11750 NE 16TH AVE APT 209
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City | NORTH MIAMI
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State | FL
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Zip | 33161-6929
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Country | US
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Telephone | 786-385-4492
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Fax | 305-673-4840
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95015461
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11006625
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License Number State | FL
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