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General NPI Number Information
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NPI Number | 1902357858
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Entity Type | Individual
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Provider Name | MELANIE MARIE GOODWIN APRN
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Gender | Female
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Dates
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Enumeration Date | 10/16/2016
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Last Update Date | 01/25/2025
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Provider Practice Location Address
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Address Line | 2720 US HIGHWAY 1 S STE B
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-6371
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Country | US
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Telephone | 904-827-0078
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Fax | 904-827-0140
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Provider Business Mailing Address
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Address Line | PO BOX 45443
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City | SALT LAKE CITY
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State | UT
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Zip | 84145-0443
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Country | US
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Telephone | 904-202-1032
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Fax | 904-376-4107
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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 | APRN9287606
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9287606
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9287606
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License Number State | FL
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