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General NPI Number Information
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NPI Number | 1265020069
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Entity Type | Individual
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Provider Name | IVONNE SUSANA GAMBOA APRN
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Gender | Female
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 3325 FOREST HILL BLVD STE A
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-5812
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Country | US
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Telephone | 561-227-5597
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Fax | 561-249-6162
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Provider Business Mailing Address
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Address Line | 3325 FOREST HILL BLVD STE A
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-5812
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Country | US
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Telephone | 561-227-5597
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Fax | 561-249-6162
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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 | APRN11040633
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License Number State | FL
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