Basic Information
Provider Information
NPI: 1518424498
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOMEZ
FirstName: YARELIS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2405 SE 17TH ST STE 201
Address2:  
City: OCALA
State: FL
PostalCode: 344719190
CountryCode: US
TelephoneNumber: 3526902171
FaxNumber: 3526906954
Practice Location
Address1: 2415 SE 17TH ST
Address2:  
City: OCALA
State: FL
PostalCode: 344712618
CountryCode: US
TelephoneNumber: 3527325365
FaxNumber: 3526906954
Other Information
ProviderEnumerationDate: 02/27/2019
LastUpdateDate: 02/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN11001089FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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