Provider Demographics
NPI:1003371790
Name:GOMEZ NOVA, ANA ALICIA (NP-C)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:ALICIA
Last Name:GOMEZ NOVA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 US HIGHWAY 82 W STE 3&4
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8200
Mailing Address - Country:US
Mailing Address - Phone:229-445-3509
Mailing Address - Fax:
Practice Address - Street 1:1909 US HIGHWAY 82 W STE 3&4
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-8200
Practice Address - Country:US
Practice Address - Phone:229-445-3509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN236233363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner