Provider Demographics
NPI:1013503762
Name:GOMEZ, AMADA LIGIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:AMADA
Middle Name:LIGIA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11750 NE 16TH AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6929
Mailing Address - Country:US
Mailing Address - Phone:786-385-4492
Mailing Address - Fax:305-673-4840
Practice Address - Street 1:1989 CITRINE WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-7012
Practice Address - Country:US
Practice Address - Phone:786-385-4492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015461363LF0000X
FL11006625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily