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General NPI Number Information
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NPI Number | 1811489180
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Entity Type | Organization
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Legal Business Name | NJ GOODWIN DO PA
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Dates
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Enumeration Date | 06/03/2018
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Last Update Date | 06/03/2018
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Provider Practice Location Address
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Address Line | 12260 TAMIAMI TRL E STE 102
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City | NAPLES
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State | FL
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Zip | 34113-7937
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Country | US
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Telephone | 239-692-9096
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Fax |
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Provider Business Mailing Address
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Address Line | 12260 TAMIAMI TRL E STE 102
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City | NAPLES
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State | FL
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Zip | 34113-7937
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Country | US
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Telephone | 813-690-5551
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NANCY J GOODWIN
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Credential | DO
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Telephone | 239-692-9096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | OS11292
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS11292
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License Number State | FL
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