Healthcare Provider Details

I. General information

NPI: 1952027948
Provider Name (Legal Business Name): AIMEE GOSS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 HALTON VILLAGE CIR
GREENVILLE SC
29607-6825
US

IV. Provider business mailing address

2 NITTANY PL
SIMPSONVILLE SC
29681-6382
US

V. Phone/Fax

Practice location:
  • Phone: 800-809-1265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5017572
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11023684
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-001170
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024186444
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26600
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: