Healthcare Provider Details

I. General information

NPI: 1477687648
Provider Name (Legal Business Name): JENNIFER GOFF YBORRA ACPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6411 FANNIN ST
HOUSTON TX
77030-1501
US

IV. Provider business mailing address

20803 GREENFIELD TRL
KINGWOOD TX
77346-1307
US

V. Phone/Fax

Practice location:
  • Phone: 832-822-0480
  • Fax:
Mailing address:
  • Phone: 281-852-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number571963
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: