Provider Demographics
NPI:1174672919
Name:GOOD, PAULINE VEVIAN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:VEVIAN
Last Name:GOOD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1394 SW 159TH LN
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5038
Mailing Address - Country:US
Mailing Address - Phone:954-435-1760
Mailing Address - Fax:954-986-0243
Practice Address - Street 1:3006 JOSIE BILLIEAVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-962-2009
Practice Address - Fax:954-986-0243
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN-2156712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN-2156712OtherNURSING LICENSE
FLA1094ZMedicare UPIN