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General NPI Number Information
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NPI Number | 1942919857
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Entity Type | Individual
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Provider Name | JESSICA L GODBEY APRN
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Gender | Female
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Dates
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Enumeration Date | 11/18/2022
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 102 LAKESHORE DR STE B
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City | SAINT MARYS
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State | GA
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Zip | 31558-3875
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Country | US
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Telephone | 912-576-7546
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Fax | 912-576-2348
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Provider Business Mailing Address
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Address Line | 95170 CORNFLOWER DR
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-0181
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Country | US
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Telephone |
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Fax | 904-376-4036
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9491954
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11023144
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License Number State | FL
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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 | GAA-NP001942
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License Number State | GA
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