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General NPI Number Information
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NPI Number | 1023657418
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Entity Type | Individual
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Provider Name | CAROLINA VEGA GOMEZ NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 01/02/2020
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 120 BEACOM BLVD
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City | MIAMI
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State | FL
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Zip | 33135-1534
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Country | US
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Telephone | 786-334-6041
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Fax |
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Provider Business Mailing Address
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Address Line | 9003 SW 214TH LN
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City | CUTLER BAY
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State | FL
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Zip | 33189-3785
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Country | US
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Telephone | 305-399-3733
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Fax |
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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 | 11004153
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License Number State | FL
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