MEDICARE: ANNETTE MICHELLE GOLUCKE CPNP-PC

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	363LP0200X	Pediatric Nurse Practitioner	AP135944	TX
2	363LP0200X	Pediatric Nurse Practitioner	CNP-03554	NM
3	363L00000X	Nurse Practitioner	CNP03554	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	659321YRND	OTHER	NM	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871091876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE MICHELLE GOLUCKE CPNP-PC

Provider Business Mailing Address
First Line	:	122 W JOHN CARPENTER FWY STE 420
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-2014
Country	:	US
Telephone Number	:	972-957-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 N ZARAGOZA RD STE A1
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-8903
Country	:	US
Telephone Number	:	915-855-7700
Fax Number	:

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

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	12/13/2021

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