MEDICARE: MRS. JENNIFER H GOMEZ FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP5420	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043633597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER H GOMEZ FNP

Provider Business Mailing Address
First Line	:	4801 E BROADWAY BLVD STE 251
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2700
Country	:	US
Telephone Number	:	520-327-0460
Fax Number	:	520-795-0225

Provider Business Practice Location Address
First Line	:	7390 N LA CHOLLA BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-2305
Country	:	US
Telephone Number	:	520-825-3547
Fax Number	:	520-825-3652

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2014
Last Update Date	:	06/25/2026

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