Provider Demographics
NPI:1891332839
Name:CARRAZANA-GOMEZ, GRETERLY (APRN)
Entity Type:Individual
Prefix:
First Name:GRETERLY
Middle Name:
Last Name:CARRAZANA-GOMEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GRETERLY
Other - Middle Name:
Other - Last Name:CARRAZANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-416-1082
Mailing Address - Fax:352-373-6144
Practice Address - Street 1:3304 SW 34TH CIRCLE
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3314
Practice Address - Country:US
Practice Address - Phone:352-401-7575
Practice Address - Fax:352-401-7577
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily