Healthcare Provider Details

I. General information

NPI: 1134085780
Provider Name (Legal Business Name): TOCCARA NICOLE GODWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21444 CARMEAN WAY
GEORGETOWN DE
19947-4572
US

IV. Provider business mailing address

21444 CARMEAN WAY
GEORGETOWN DE
19947-4572
US

V. Phone/Fax

Practice location:
  • Phone: 302-855-1233
  • Fax: 302-654-1061
Mailing address:
  • Phone: 302-855-1233
  • Fax: 302-654-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number000108699
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: