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General NPI Number Information
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NPI Number | 1255617783
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Entity Type | Individual
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Provider Name | LISA GODDARD APRN
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Gender | Female
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Dates
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Enumeration Date | 10/28/2011
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 1395 W BAY DR
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City | LARGO
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State | FL
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Zip | 33770-2205
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Country | US
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Telephone | 727-584-6802
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Fax |
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Provider Business Mailing Address
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Address Line | 5364 ELISEO ST
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City | SARASOTA
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State | FL
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Zip | 34238-4791
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Country | US
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Telephone | 407-831-6200
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Fax | 407-831-1068
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN9327272
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License Number State | FL
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