Healthcare Provider Details

I. General information

NPI: 1205621372
Provider Name (Legal Business Name): NICOLE GOTJE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 NEWBERRY RD STE 104
GAINESVILLE FL
32607-2557
US

IV. Provider business mailing address

4340 NEWBERRY RD STE 104
GAINESVILLE FL
32607-2557
US

V. Phone/Fax

Practice location:
  • Phone: 352-240-6209
  • Fax:
Mailing address:
  • Phone: 352-240-6209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License NumberCRT64062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: