Provider Demographics
NPI:1437240470
Name:GOSS, ANITA JUDITH (NP PHD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:JUDITH
Last Name:GOSS
Suffix:
Gender:F
Credentials:NP PHD
Other - Prefix:MRS
Other - First Name:ANITA
Other - Middle Name:JUDITH
Other - Last Name:DEGROFFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN MS
Mailing Address - Street 1:3575 E THIMBLE PEAK PLACE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718
Mailing Address - Country:US
Mailing Address - Phone:520-792-1450
Mailing Address - Fax:
Practice Address - Street 1:3601 S 6TH ST
Practice Address - Street 2:4116A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN045895363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner