Provider Demographics
NPI:1265020069
Name:GAMBOA, IVONNE SUSANA (APRN)
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:SUSANA
Last Name:GAMBOA
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 1:3325 FOREST HILL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5812
Mailing Address - Country:US
Mailing Address - Phone:561-227-5597
Mailing Address - Fax:561-249-6162
Practice Address - Street 1:3325 FOREST HILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5812
Practice Address - Country:US
Practice Address - Phone:561-227-5597
Practice Address - Fax:561-249-6162
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11040633363LF0000X
NJNJDCATEMP-037072208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty