MEDICARE: ROBERTA GOODEN APRN

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	363LF0000X	Family Nurse Practitioner	APRN11027150	FL

General Provider Information

NPI Number	:	1720739212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA GOODEN APRN

Provider Business Mailing Address
First Line	:	10075 S JOG RD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3535
Country	:	US
Telephone Number	:	561-652-8652
Fax Number	:	561-652-8653

Provider Business Practice Location Address
First Line	:	10075 S JOG RD STE 101
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3532
Country	:	US
Telephone Number	:	561-652-8652
Fax Number	:	561-652-8653

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

Provider Enumeration Date	:	01/16/2022
Last Update Date	:	02/04/2026

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