Provider Demographics
NPI:1023657418
Name:VEGA GOMEZ, CAROLINA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:VEGA GOMEZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9003 SW 214TH LN
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3785
Mailing Address - Country:US
Mailing Address - Phone:305-399-3733
Mailing Address - Fax:
Practice Address - Street 1:120 BEACOM BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1534
Practice Address - Country:US
Practice Address - Phone:786-334-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily