Healthcare Provider Details

I. General information

NPI: 1720488091
Provider Name (Legal Business Name): GODDESS MINGO APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2014
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 STATE RD
PARMA OH
44134-2869
US

IV. Provider business mailing address

9462 ACKLEY RD
PARMA HEIGHTS OH
44130-2327
US

V. Phone/Fax

Practice location:
  • Phone: 440-731-5887
  • Fax:
Mailing address:
  • Phone: 440-731-5887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0040242
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number422797
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number156494
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: