Provider Demographics
NPI:1558775791
Name:GOMEZ DORATI, NICOLE I
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:I
Last Name:GOMEZ DORATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N ORANGE BLOSSOM TRL STE 302
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2308
Mailing Address - Country:US
Mailing Address - Phone:407-932-6193
Mailing Address - Fax:407-932-6194
Practice Address - Street 1:2400 N ORANGE BLOSSOM TRL STE 302
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2308
Practice Address - Country:US
Practice Address - Phone:407-932-6193
Practice Address - Fax:407-932-6194
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME135373207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program