Healthcare Provider Details

I. General information

NPI: 1548773039
Provider Name (Legal Business Name): GOLDUNN YEARS GERIATRIC MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5355 SPRING HILL DR
SPRING HILL FL
34606-4540
US

IV. Provider business mailing address

5355 SPRING HILL DR
SPRING HILL FL
34606-4540
US

V. Phone/Fax

Practice location:
  • Phone: 352-616-0075
  • Fax: 352-616-0072
Mailing address:
  • Phone: 352-616-0075
  • Fax: 352-616-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CATERINA GOLDBERG-DUNNETT
Title or Position: OWNER
Credential: ARNP
Phone: 352-616-0075