Healthcare Provider Details

I. General information

NPI: 1275040776
Provider Name (Legal Business Name): SAMANTHA DAWN GOOSS MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 09/24/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 QUAKER AVE
LUBBOCK TX
79424
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 35
LUBBOCK TX
79407-3545
US

V. Phone/Fax

Practice location:
  • Phone: 806-788-3306
  • Fax: 806-722-3861
Mailing address:
  • Phone: 806-761-0333
  • Fax: 806-782-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number56275
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9466740
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142472
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: