Provider Demographics
NPI:1336854504
Name:GOMEZ, JUSTIN ANTHONY (FNP-C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ANTHONY
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3187 E 3050 S
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1372
Mailing Address - Country:US
Mailing Address - Phone:484-288-0756
Mailing Address - Fax:
Practice Address - Street 1:1299 BERTHA HOWE AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-7500
Practice Address - Country:US
Practice Address - Phone:702-346-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV863840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily