Individual provider Active NPI

Mayelin Gomez, ARNP-C

  • Adult Health Nurse Practitioner
  • Fort Myers, FL
National Provider Identifier
1770618860
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
ARNP3049922 Issued in FL
Practice address
16410 Healthpark Commons Dr
Fort Myers, FL 33908
Phone
(239) 343-6202
Fax
(239) 437-8537
NPI assigned
Feb 22, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X ARNP3049922 FL Primary

Addresses

Primary practice location

16410 Healthpark Commons Dr
Fort Myers, FL 33908

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-6202

Other practice location 1

1120 15th St
Augusta, GA 30912-1051
Phone (706) 721-8623

Other identifiers 1

IdentifierTypeStateIssuer
103204700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170109002222 GA Practitioner - Nurse Practitioner 9537440433 Reassigns benefits to 3 organizations
I20190716000736 FL Practitioner - Nurse Practitioner 9537440433 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP3049922FLMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Au Medical Center, Inc. CurrentSince Nov 28, 2016 Accepting new patients
Au Medical Associates Inc CurrentSince Dec 1, 2018 Accepting new patients
Au Medical Associates Inc CurrentSince Dec 1, 2018 Accepting new patients
Au Medical Center, Inc CurrentSince Nov 28, 2016 Accepting new patients
Community Care Health Network LLC CurrentSince Oct 1, 2025 Accepting new patients

Locations

9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883

2202 N West Shore Blvd
Ste 200
Tampa, FL 33607
Phone (317) 452-4352

2202 N West Shore Blvd
Tampa, FL 33607
Phone (813) 416-4680

1000 Parkwood Cir SE
Ste 900
Atlanta, GA 30339
Phone (216) 393-8684

1120 15th St
Ste BI1056
Augusta, GA 30912
Phone (706) 721-2785

1120 15th St
Augusta, GA 30912
Phone (706) 721-3873

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1770618860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-343-6202",
            "fax_number": "239-437-8537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16410 HEALTHPARK COMMONS DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33908",
            "telephone_number": "239-343-6202",
            "fax_number": "239-437-8537"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1120 15th St",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309121051",
            "country_code": "US",
            "telephone_number": "706-721-8623",
            "fax_number": "706-721-1459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "MAYELIN",
        "name_prefix": "Ms.",
        "credential": "ARNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "ARNP3049922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103204700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.