MEDICARE: JACINTA GODWIN

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	164W00000X	Licensed Practical Nurse	284276	NY

General Provider Information

NPI Number	:	1861633026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACINTA GODWIN

Provider Business Mailing Address
First Line	:	831 GERARD AVE
Second Line	:	APT 3-E
City	:	BRONX
State	:	NY
Zip	:	10451-2229
Country	:	US
Telephone Number	:	718-924-8034
Fax Number	:

Provider Business Practice Location Address
First Line	:	831 GERARD AVE
Second Line	:	APT 3-E
City	:	BRONX
State	:	NY
Zip	:	10451-2229
Country	:	US
Telephone Number	:	718-924-8034
Fax Number	:

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

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	03/18/2009

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Directions to “ JACINTA GODWIN ” Practice Location

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