Provider Demographics
NPI:1093441677
Name:GOMEZ, ILONA ISABEL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ILONA
Middle Name:ISABEL
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13661 LEYDEN CT
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-6986
Mailing Address - Country:US
Mailing Address - Phone:303-550-5201
Mailing Address - Fax:
Practice Address - Street 1:8820 HURON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-6805
Practice Address - Country:US
Practice Address - Phone:303-386-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997724-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty