Provider Demographics
NPI:1386046019
Name:GOAD, AMY ELIZABETH (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:GOAD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:115 LA GRANGE AVE UNIT A
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-9597
Mailing Address - Country:US
Mailing Address - Phone:301-392-1935
Mailing Address - Fax:301-392-1936
Practice Address - Street 1:115 LA GRANGE AVE UNIT A
Practice Address - Street 2:SUITE 101
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-9597
Practice Address - Country:US
Practice Address - Phone:301-392-1935
Practice Address - Fax:301-392-1936
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily