Provider Demographics
NPI:1316554181
Name:GOGGANS, ADRIENNE BOLAN (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:BOLAN
Last Name:GOGGANS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 FRIENDSHIP ROAD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078
Mailing Address - Country:US
Mailing Address - Phone:334-283-3111
Mailing Address - Fax:334-283-3656
Practice Address - Street 1:875 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078
Practice Address - Country:US
Practice Address - Phone:334-283-3111
Practice Address - Fax:334-283-3656
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-155461363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL261689Medicaid