Provider Demographics
NPI:1164970364
Name:GOSS, BRYAN JOHN (ACNP)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JOHN
Last Name:GOSS
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 SE 18TH AVE
Mailing Address - Street 2:APT 1905
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8240
Mailing Address - Country:US
Mailing Address - Phone:941-704-3258
Mailing Address - Fax:
Practice Address - Street 1:1200 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3494
Practice Address - Country:US
Practice Address - Phone:304-598-1330
Practice Address - Fax:304-598-1609
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV107699363LG0600X, 363LF0000X, 364SE0003X
FLARNP9374626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency