Provider Demographics
NPI:1336145671
Name:VELOSO-GOMEZ, DONNA JENNIFER (RPA-C)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JENNIFER
Last Name:VELOSO-GOMEZ
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:JENNIFER
Other - Last Name:VELUSA-GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPA-C
Mailing Address - Street 1:9165 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2302
Mailing Address - Country:US
Mailing Address - Phone:305-233-0011
Mailing Address - Fax:305-233-0033
Practice Address - Street 1:9165 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2302
Practice Address - Country:US
Practice Address - Phone:305-233-0011
Practice Address - Fax:305-233-0033
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
592417574001OtherCHAMPUS/TRICARE
S91763Medicare UPIN
FLE3198UMedicare PIN