Healthcare Provider Details

I. General information

NPI: 1710279815
Provider Name (Legal Business Name): LAUREN AUDREY GOODSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2011
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

4820 SW 70TH TER
DAVIE FL
33314-4106
US

V. Phone/Fax

Practice location:
  • Phone: 352-262-2130
  • Fax:
Mailing address:
  • Phone: 352-262-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number9248052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: