Provider Demographics
NPI:1023006467
Name:GOODMAN, DAVID JASON (ARNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JASON
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611B SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5520
Mailing Address - Country:US
Mailing Address - Phone:352-629-8881
Mailing Address - Fax:352-629-1220
Practice Address - Street 1:2611B SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5520
Practice Address - Country:US
Practice Address - Phone:352-629-8881
Practice Address - Fax:352-629-1220
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2570302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP63345Medicare UPIN
FLE1642ZMedicare PIN