MEDICARE: MRS. SONYA CHRISTINA GOODMAN CERTIFICATION

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
1	372600000X	Adult Companion	20291	FL
2	376K00000X	Nurse's Aide	20291	FL
3	374U00000X	Home Health Aide	20291	FL
4	376J00000X	Homemaker	20291	FL
5	376K00000X	Nurse's Aide
6	385H00000X	Respite Care	20291	FL

General Provider Information

NPI Number	:	1588169338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SONYA CHRISTINA GOODMAN CERTIFICATION

Provider Business Mailing Address
First Line	:	6548 SANDLER LAKES DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-1690
Country	:	US
Telephone Number	:	904-444-7943
Fax Number	:

Provider Business Practice Location Address
First Line	:	6548 SANDLER LAKES DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-1690
Country	:	US
Telephone Number	:	904-672-7454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	02/28/2021

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