Provider Demographics
NPI:1669545349
Name:GAMBOA, MA VERONICA CRU (ARNP)
Entity type:Individual
Prefix:
First Name:MA VERONICA
Middle Name:CRU
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7008
Mailing Address - Country:US
Mailing Address - Phone:954-345-4333
Mailing Address - Fax:
Practice Address - Street 1:722 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7008
Practice Address - Country:US
Practice Address - Phone:954-345-4333
Practice Address - Fax:954-345-4334
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP755042363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
U06082Medicare ID - Type Unspecified