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NPI Code Detail

MEDICARE: CHASSITIE L GOMEZ APRN

MEDICARE: CHASSITIE L GOMEZ 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
1163W00000XRegistered Nurse0001234356VA
2363LF0000XFamily Nurse PractitionerAPRN11005890FL
3363LF0000XFamily Nurse Practitioner0024176292VA

Other Identifiers

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

General Provider Information

NPI Number : 1720574726
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHASSITIE L GOMEZ APRN
Provider Business Mailing Address
First Line : 7855 ARGYLE FOREST BLVD STE 101
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32244-5597
Country : US
Telephone Number : 904-282-6331
Fax Number :
Provider Business Practice Location Address
First Line : 2901 S LYNNHAVEN RD STE 450
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-8524
Country : US
Telephone Number : 757-536-2246
Fax Number : 757-965-9806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2018
Last Update Date : 10/07/2022

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Directions to “ CHASSITIE L GOMEZ APRN” Practice Location

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