Provider Demographics
NPI:1962044016
Name:GOMEZ, MARIAISYS (APRN)
Entity Type:Individual
Prefix:
First Name:MARIAISYS
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15255 MAX LEGGETT PKWY STE 4000
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-7277
Mailing Address - Country:US
Mailing Address - Phone:904-383-1540
Mailing Address - Fax:904-383-1413
Practice Address - Street 1:15255 MAX LEGGETT PKWY STE 4000
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7277
Practice Address - Country:US
Practice Address - Phone:904-383-1540
Practice Address - Fax:904-383-1413
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004148363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104567600Medicaid