Provider Demographics
NPI:1720620461
Name:ALVAREZ GOMEZ, IDALMIS (APRN)
Entity Type:Individual
Prefix:
First Name:IDALMIS
Middle Name:
Last Name:ALVAREZ 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 1:16881 SW 146TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2039
Mailing Address - Country:US
Mailing Address - Phone:817-538-4455
Mailing Address - Fax:
Practice Address - Street 1:16881 SW 146TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2039
Practice Address - Country:US
Practice Address - Phone:817-538-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily