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General NPI Number Information
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NPI Number | 1861751026
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Entity Type | Individual
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Provider Name | IRENE GOMEZ APRN
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Gender | Female
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 2624 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-3609
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Country | US
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Telephone | 904-513-3240
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Fax | 904-398-7871
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Provider Business Mailing Address
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Address Line | 3564 89TH ST APT 5C
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-5766
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Country | US
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Telephone | 216-224-0798
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN11028156
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 303828-1
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License Number State | NY
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