Provider Demographics
NPI:1235814336
Name:GOGGINS-SYX, LANEA SHEREE
Entity Type:Individual
Prefix:
First Name:LANEA
Middle Name:SHEREE
Last Name:GOGGINS-SYX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 MEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2108
Mailing Address - Country:US
Mailing Address - Phone:205-820-2400
Mailing Address - Fax:
Practice Address - Street 1:5300 MEDFORD DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2108
Practice Address - Country:US
Practice Address - Phone:205-820-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-08370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily