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General NPI Number Information
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NPI Number | 1225083082
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Entity Type | Individual
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Provider Name | MARY JEAN GOSSMAN MPAS, PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 105 NW SANTA FE BLVD HIGH SPRINGS MEDICAL CENTER
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City | HIGH SPRINGS
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State | FL
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Zip | 32655
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Country | US
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Telephone | 386-454-7746
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Fax |
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Provider Business Mailing Address
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Address Line | 18808 NW 72ND AVE
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City | ALACHUA
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State | FL
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Zip | 32615-7599
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Country | US
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Telephone | 386-418-0111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1809
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License Number State | FL
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