Healthcare Provider Details

I. General information

NPI: 1770521874
Provider Name (Legal Business Name): DEBORAH JEAN GODDARD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-3707
US

IV. Provider business mailing address

555 N BYRON BUTLER PKWY
PERRY FL
32347-2315
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-4747
  • Fax: 904-819-5080
Mailing address:
  • Phone: 850-223-5400
  • Fax: 850-223-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 3353562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: