Provider Demographics
NPI:1518598010
Name:GOFF, GARRETT THOMAS (RN, BSN, NIH)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:THOMAS
Last Name:GOFF
Suffix:
Gender:M
Credentials:RN, BSN, NIH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 GRAND VISTA CIR APT 110
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-5253
Mailing Address - Country:US
Mailing Address - Phone:214-726-6105
Mailing Address - Fax:469-533-8668
Practice Address - Street 1:2135 SOUTHGATE RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-2693
Practice Address - Country:US
Practice Address - Phone:719-329-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX980416163W00000X, 163WA0400X, 163WP0808X
CO1667133163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORN.1667133OtherREGISTERED NURSE LICENSE
NJNJDCATEMP-000803OtherREGISTERED PROFESSIONAL NURSE
TX980416OtherREGISTERED NURSE LIC. TEXAS BON (ORIGINAL ISSUING AGENCY)