MEDICARE: MARIAISYS 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
1	363LP0200X	Pediatric Nurse Practitioner	APRN11004148	FL

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	:	1962044016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAISYS GOMEZ APRN

Provider Business Mailing Address
First Line	:	15255 MAX LEGGETT PKWY STE 4000
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-7277
Country	:	US
Telephone Number	:	904-383-1540
Fax Number	:	904-383-1413

Provider Business Practice Location Address
First Line	:	15255 MAX LEGGETT PKWY STE 4000
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-7277
Country	:	US
Telephone Number	:	904-383-1540
Fax Number	:	904-383-1413

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

Provider Enumeration Date	:	10/10/2019
Last Update Date	:	03/31/2023

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