Provider Demographics
NPI:1003341892
Name:BOU GOMEZ, YANET (ARNP)
Entity Type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:BOU GOMEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 SW 30TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1249
Mailing Address - Country:US
Mailing Address - Phone:305-300-6883
Mailing Address - Fax:
Practice Address - Street 1:95 SW 30TH AVE APT 5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1249
Practice Address - Country:US
Practice Address - Phone:305-300-6883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-29
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9352092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily