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General NPI Number Information
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NPI Number | 1831345974
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Entity Type | Individual
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Provider Name | HEATHER MELISSA GOODSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 900 CARILLON PKWY SUITE 311
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City | ST PETERSBURG
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State | FL
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Zip | 33716-1115
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Country | US
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Telephone | 727-573-5626
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Fax | 727-573-5627
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Provider Business Mailing Address
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Address Line | 900 CARILLON PKWY SUITE 311
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City | ST PETERSBURG
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State | FL
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Zip | 33716-1115
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Country | US
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Telephone | 727-573-5626
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Fax | 727-573-5627
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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 | PAT9104621
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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