Provider Demographics
NPI:1841749132
Name:GOMEZ, KRISTA KAYE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:KAYE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12438 W SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-3448
Mailing Address - Country:US
Mailing Address - Phone:480-747-2001
Mailing Address - Fax:
Practice Address - Street 1:13640 N 99TH AVE STE 600
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2867
Practice Address - Country:US
Practice Address - Phone:623-972-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily