=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326150020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE LEE GOFF PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 05/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27612 CASHFORD CIR STE 102
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33544-6954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-400-3376
-----------------------------------------------------
Fax | 813-907-2706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 151 SOUTHHALL LN STE 300
-----------------------------------------------------
City | MAITLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32751-7172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-400-3376
-----------------------------------------------------
Fax | 407-650-3455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9103771
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------