Healthcare Provider Details

I. General information

NPI: 1316554181
Provider Name (Legal Business Name): ADRIENNE BOLAN GOGGANS CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 12/01/2023
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 FRIENDSHIP RD
TALLASSEE AL
36078
US

IV. Provider business mailing address

875 FRIENDSHIP ROAD
TALLASSEE AL
36078
US

V. Phone/Fax

Practice location:
  • Phone: 334-283-3111
  • Fax: 334-283-3656
Mailing address:
  • Phone: 334-283-3111
  • Fax: 334-283-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-155461
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: