MEDICARE: PATRICE GAMBOA FNP-C, BSN

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	163W00000X	Registered Nurse	RN89221	NV

General Provider Information

NPI Number	:	1154266872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE GAMBOA FNP-C, BSN

Provider Business Mailing Address
First Line	:	1081 BARBY SPRINGS AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-6819
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 BARBY SPRINGS AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-6819
Country	:	US
Telephone Number	:	702-409-2454
Fax Number	:

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

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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