Healthcare Provider Details

I. General information

NPI: 1841224482
Provider Name (Legal Business Name): APRIL ANN GODDARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: APRIL ANN TILTON

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD #100217
GAINESVILLE FL
32610-0214
US

IV. Provider business mailing address

PO BOX 100214 1600 SW ARCHER RD
GAINESVILLE FL
32610-0214
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9483
  • Fax: 352-392-3618
Mailing address:
  • Phone: 352-273-9483
  • Fax: 352-392-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9101109
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101109
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: