Healthcare Provider Details

I. General information

NPI: 1245267822
Provider Name (Legal Business Name): PATRICIA A GOODE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA A MCMAHON ARNP

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 S PATRICK DR
SATELLITE BEACH FL
32937-4375
US

IV. Provider business mailing address

PO BOX 361095
MELBOURNE FL
32936-1095
US

V. Phone/Fax

Practice location:
  • Phone: 321-773-2659
  • Fax: 321-773-2667
Mailing address:
  • Phone: 321-773-2659
  • Fax: 321-773-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2144042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: