Provider Demographics
NPI:1699005538
Name:GOMEZ, JOHNNY EDWARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:EDWARD
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2250 NW 136TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2628
Mailing Address - Country:US
Mailing Address - Phone:954-302-7960
Mailing Address - Fax:954-628-5084
Practice Address - Street 1:2250 NW 136TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2628
Practice Address - Country:US
Practice Address - Phone:954-302-7960
Practice Address - Fax:954-628-5084
Is Sole Proprietor?:No
Enumeration Date:2009-12-27
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105188363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical