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NPI Code Detail

MEDICARE: JENNIFER MARIE GOFORTH FNP

MEDICARE: JENNIFER MARIE GOFORTH FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse Practitioner10602CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110602OTHERCALICENSE

General Provider Information

NPI Number : 1134148521
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MARIE GOFORTH FNP
Provider Business Mailing Address
First Line : 900 THARP RD
Second Line :
City : YUBA CITY
State : CA
Zip : 95993-9159
Country : US
Telephone Number : 530-844-5655
Fax Number : 530-821-2030
Provider Business Practice Location Address
First Line : 900 THARP RD
Second Line :
City : YUBA CITY
State : CA
Zip : 95993-9159
Country : US
Telephone Number : 530-844-5655
Fax Number : 530-821-2030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 02/20/2023

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