Healthcare Provider Details

I. General information

NPI: 1831576669
Provider Name (Legal Business Name): PAUL CURTIS GOFF APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 E LION LN STE 160
SALT LAKE CITY UT
84121-3514
US

IV. Provider business mailing address

2913 5TH AVE NE STE 101
PUYALLUP WA
98372-6748
US

V. Phone/Fax

Practice location:
  • Phone: 855-255-1750
  • Fax: 855-255-0905
Mailing address:
  • Phone: 855-255-1750
  • Fax: 855-255-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number372185-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number372185-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: