Healthcare Provider Details

I. General information

NPI: 1568628626
Provider Name (Legal Business Name): ROBERTA ANN GOFF FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 NORTHPORT AVE
BELFAST ME
04915-6009
US

IV. Provider business mailing address

119 NORTHPORT AVE
BELFAST ME
04915-6069
US

V. Phone/Fax

Practice location:
  • Phone: 207-930-2639
  • Fax: 207-338-8368
Mailing address:
  • Phone: 207-505-4567
  • Fax: 207-505-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR039186
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: