MEDICARE: JUAN MANUEL GOMEZ TORRES APRN

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	363L00000X	Nurse Practitioner	APRN11022616	FL

General Provider Information

NPI Number	:	1083316186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN MANUEL GOMEZ TORRES APRN

Provider Business Mailing Address
First Line	:	5825 W 25TH CT APT 102
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-4463
Country	:	US
Telephone Number	:	786-247-6625
Fax Number	:

Provider Business Practice Location Address
First Line	:	5825 W 25TH CT APT 102
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-4463
Country	:	US
Telephone Number	:	786-247-6625
Fax Number	:

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

Provider Enumeration Date	:	03/21/2023
Last Update Date	:	03/21/2023

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