CHASSITIE L GOMEZ APRN NPI 1720574726

NPI Information

NPI: 1720574726
Provider Name: CHASSITIE L GOMEZ, APRN
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

Organization: PHYSICIANS GROUP SERVICES PA

PECOS Registration: Yes

Address:
14810 OLD SAINT AUGUSTINE RD STE 101
JACKSONVILLE, FL
ZIP 32258
Phone: (904) 260-4111
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Chassitie L Gomez, APRN is a family nurse practitioner in Jacksonville, FL with 6 years of experience. Chassitie L Gomez, APRN NPI is 1720574726. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

14810 OLD SAINT AUGUSTINE RD STE 101
JACKSONVILLE, FL
ZIP 32258-558
Phone: (904) 260-4111
Fax: (904) 264-9750

The NPI 1720574726 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/3/2018 and was last updated on 6/4/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163W00000X	Registered Nurse		0001234356	VIRGINIA	No
2	363LF0000X	Nurse Practitioner	Family	APRN11005890	FLORIDA	Yes
3	363LF0000X	Nurse Practitioner	Family	0024176292	VIRGINIA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	105822400	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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