Provider Demographics
NPI:1609529700
Name:GOMEZ, ROBERTO (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 GASLIGHT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3187
Mailing Address - Country:US
Mailing Address - Phone:936-639-0988
Mailing Address - Fax:936-639-0991
Practice Address - Street 1:710 GASLIGHT BLVD STE A
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3187
Practice Address - Country:US
Practice Address - Phone:936-639-0988
Practice Address - Fax:936-639-0991
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily