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General NPI Number Information
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NPI Number | 1396376620
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Entity Type | Individual
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Provider Name | JILL D GOSS APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 3073 WHITE MOUNTAIN HWY
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City | NORTH CONWAY
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State | NH
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Zip | 03860-7101
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Country | US
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Telephone | 603-356-5461
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Fax |
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Provider Business Mailing Address
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Address Line | 1133 CHOCORUA RD UNIT 9
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City | TAMWORTH
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State | NH
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Zip | 03886-5025
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Country | US
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Telephone | 603-393-7326
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | PENDING
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 040280-21
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 040280-23
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License Number State | NH
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