Provider Demographics
NPI:1518185693
Name:GOODWIN, JENNIFER M (FNP C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:1330 CEDAR LANE BLDG B SUITE 900
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-1327
Mailing Address - Country:US
Mailing Address - Phone:931-455-2674
Mailing Address - Fax:931-455-8983
Practice Address - Street 1:1330 CEDAR LN STE 900 BLDG B
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2286
Practice Address - Country:US
Practice Address - Phone:931-455-2674
Practice Address - Fax:931-455-8983
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN11120363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1504384Medicaid