Provider Demographics
NPI:1508160482
Name:GOEMAN, STEPHANIE DIANE (PA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DIANE
Last Name:GOEMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 LILLIAN LN
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-4561
Mailing Address - Country:US
Mailing Address - Phone:813-389-2520
Mailing Address - Fax:
Practice Address - Street 1:1214 GALLATIN AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3242
Practice Address - Country:US
Practice Address - Phone:615-988-1620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2115363A00000X
GA005991363AM0700X
TN3391363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical