Healthcare Provider Details

I. General information

NPI: 1639095433
Provider Name (Legal Business Name): MRS. DELORES LORETTA GOODMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 S US HIGHWAY 27 STE 5
CLERMONT FL
34711-8600
US

IV. Provider business mailing address

8100 KERSEY ST APT 8106
DAVENPORT FL
33897-9649
US

V. Phone/Fax

Practice location:
  • Phone: 352-227-3000
  • Fax: 352-505-7738
Mailing address:
  • Phone: 352-255-7483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: