Provider Demographics
NPI:1053877977
Name:GOMEZ, AILYN (FNP)
Entity type:Individual
Prefix:MRS
First Name:AILYN
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AILYN MARIE
Other - Middle Name:MONAKIL
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1013 VALLEY LIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011
Mailing Address - Country:US
Mailing Address - Phone:702-306-4591
Mailing Address - Fax:
Practice Address - Street 1:3750 S. JONES BLVD.
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2209
Practice Address - Country:US
Practice Address - Phone:702-434-8880
Practice Address - Fax:702-862-8880
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV816652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner