Provider Demographics
NPI:1043633597
Name:GOMEZ, JENNIFER H (FNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:H
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:A-100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:7390 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2305
Practice Address - Country:US
Practice Address - Phone:520-825-3547
Practice Address - Fax:520-825-3652
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP5420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ894851Medicaid
AZ894851Medicaid