Healthcare Provider Details

I. General information

NPI: 1811993587
Provider Name (Legal Business Name): JILL ANNE GOFF C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W WENGER RD
ENGLEWOOD OH
45322-2722
US

IV. Provider business mailing address

20 W WENGER RD
ENGLEWOOD OH
45322-2722
US

V. Phone/Fax

Practice location:
  • Phone: 937-771-5100
  • Fax: 937-832-3014
Mailing address:
  • Phone: 937-771-5100
  • Fax: 937-832-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number01698-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: