Provider Demographics
NPI:1487350369
Name:GOMEZ MARTINEZ, IALA (APRN)
Entity type:Individual
Prefix:
First Name:IALA
Middle Name:
Last Name:GOMEZ MARTINEZ
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 1:6738 MARINA POINTE VILLAGE CT APT 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-9003
Mailing Address - Country:US
Mailing Address - Phone:346-368-9273
Mailing Address - Fax:
Practice Address - Street 1:6738 MARINA POINTE VILLAGE CT APT 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-9003
Practice Address - Country:US
Practice Address - Phone:346-368-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017168363LF0000X
FL11024910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG525-400-84-525-0OtherDRIVE LICENCE