Provider Demographics
NPI:1508562414
Name:GOODLET, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:GOODLET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 SAVANNAH OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-9110
Mailing Address - Country:US
Mailing Address - Phone:727-744-6287
Mailing Address - Fax:
Practice Address - Street 1:531 MAIN ST STE H
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3558
Practice Address - Country:US
Practice Address - Phone:727-491-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022709363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner