Provider Demographics
NPI:1821461476
Name:GOMRAD, ALICIA (ARNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:GOMRAD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 SENECA MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4730
Mailing Address - Country:US
Mailing Address - Phone:321-279-0896
Mailing Address - Fax:
Practice Address - Street 1:210 LOOKOUT PL
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4491
Practice Address - Country:US
Practice Address - Phone:407-215-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9266605363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics