Healthcare Provider Details

I. General information

NPI: 1689769036
Provider Name (Legal Business Name): JENNIFER C MCGOFF ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E RIDGE RD STE 20
ROCHESTER NY
14621-1239
US

IV. Provider business mailing address

312 CHERRY CREEK LANE
ROCHESTER NY
14626
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-0400
  • Fax: 585-922-0455
Mailing address:
  • Phone: 585-922-0400
  • Fax: 585-922-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number430312
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: