Provider Demographics
NPI:1376514091
Name:GOODMAN, JOYCE M (PA)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:M
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:7751 BAYMEADOWS RD E STE H
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5836
Practice Address - Country:US
Practice Address - Phone:904-425-6963
Practice Address - Fax:904-674-0155
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101604363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0Q73OtherBCBS
FL020808200Medicaid
FLLP713OtherMEDICARE