Healthcare Provider Details

I. General information

NPI: 1487730552
Provider Name (Legal Business Name): JENNIFER CHRISTIE GOODWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12955 PALMS WEST DR BUILDING 8, SUITE 100
LOXAHATCHEE FL
33470-4993
US

IV. Provider business mailing address

8200 S JOG RD SUITE 203
BOYNTON BEACH FL
33472-2981
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-2468
  • Fax: 561-798-2773
Mailing address:
  • Phone: 561-327-4960
  • Fax: 561-738-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME100876
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: