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NPI Code Detail

MEDICARE: MRS. JACQUELINE A GOMOGDA RNC, WHNP,ARNP

MEDICARE: MRS. JACQUELINE A GOMOGDA RNC, WHNP,ARNP
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
1363LW0102XWomen's Health Nurse Practitioner2698092FL

General Provider Information

NPI Number : 1770551632
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACQUELINE A GOMOGDA RNC, WHNP,ARNP
Provider Business Mailing Address
First Line : 700 8TH AVE W
Second Line : STE 101
City : PALMETTO
State : FL
Zip : 34221-4737
Country : US
Telephone Number : 941-776-4008
Fax Number : 941-845-4963
Provider Business Practice Location Address
First Line : 12271 US HIGHWAY 301 N
Second Line :
City : PARRISH
State : FL
Zip : 34219-8410
Country : US
Telephone Number : 941-776-4050
Fax Number : 941-776-4057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 03/24/2017

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