Provider Demographics
NPI:1205449113
Name:GOMEZ, ALEXANDRA (NP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 ESPLANADE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5405
Mailing Address - Country:US
Mailing Address - Phone:718-918-1100
Mailing Address - Fax:718-918-1106
Practice Address - Street 1:2233 ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5405
Practice Address - Country:US
Practice Address - Phone:718-918-1100
Practice Address - Fax:718-918-1106
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309898363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health