Active NPI
Leeya Renee Gomez, PA-C
- Physician Assistant
- Orlando, FL
National Provider Identifier
1184876005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9104339
- Practice address
- 2501 N Orange Ave
Suite 381
Orlando, FL 32804-4623 - Phone
- (407) 898-5452
- Fax
- (407) 898-1183
- NPI assigned
- Oct 22, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9104339 | FL | Primary |
Addresses
Primary practice location
2501 N Orange Ave
Suite 381
Orlando, FL 32804-4623
Mailing address
4371 Veronica S. Shoemaker Blvd
Attn: Credentialing Department
Fort Myers, FL 33916-2216
Phone (239) 274-8200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9104339 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441843200000",
"number": "1184876005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4371 VERONICA S. SHOEMAKER BLVD",
"address_2": "ATTN: CREDENTIALING DEPARTMENT",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339162216",
"telephone_number": "239-274-8200",
"fax_number": "239-278-3350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2501 N ORANGE AVE",
"address_2": "SUITE 381",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328044623",
"telephone_number": "407-898-5452",
"fax_number": "407-898-1183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMEZ",
"first_name": "LEEYA",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-22",
"last_updated": "2015-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9104339",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.