Provider Demographics
NPI:1346846060
Name:GOODMAN, ANGELA SIMONE (CNM)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:SIMONE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:CNM
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Other - Credentials:
Mailing Address - Street 1:8851 IVYMILL PL N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6316
Mailing Address - Country:US
Mailing Address - Phone:904-868-8490
Mailing Address - Fax:
Practice Address - Street 1:4203 BELFORT RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1409
Practice Address - Country:US
Practice Address - Phone:904-405-0504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife