Provider Demographics
NPI:1376977934
Name:GOMEZ, NINA ANGELA (NP)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:ANGELA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:ANGELA
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 E VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-3742
Mailing Address - Country:US
Mailing Address - Phone:602-790-8809
Mailing Address - Fax:602-251-8795
Practice Address - Street 1:1800 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3742
Practice Address - Country:US
Practice Address - Phone:602-251-8535
Practice Address - Fax:602-251-8180
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5156363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health