Provider Demographics
NPI:1255846903
Name:GOMEZ, RICARDO A (ARNP)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:A
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 W 56TH ST APT 303
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7308
Mailing Address - Country:US
Mailing Address - Phone:305-557-9038
Mailing Address - Fax:
Practice Address - Street 1:4200 SW 54TH CT
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33314-6726
Practice Address - Country:US
Practice Address - Phone:754-312-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9356566363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health