Healthcare Provider Details

I. General information

NPI: 1942946363
Provider Name (Legal Business Name): CAROLYN GOODSON APRN, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 SE EDGEWOOD DR
STUART FL
34996-4713
US

IV. Provider business mailing address

431 SE EDGEWOOD DR
STUART FL
34996-4713
US

V. Phone/Fax

Practice location:
  • Phone: 772-214-5983
  • Fax:
Mailing address:
  • Phone: 772-214-5983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN2037882
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberNA
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: