Provider Demographics
NPI:1518916519
Name:GOC, KIMBERLY ANN (NP)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:ANN
Last Name:GOC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:300 MOUNT AUBURN ST
Mailing Address - Street 2:STE 517
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5600
Mailing Address - Country:US
Mailing Address - Phone:617-868-0847
Mailing Address - Fax:617-491-6048
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:STE 517
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-868-0847
Practice Address - Fax:617-491-6048
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA201316363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS10593Medicare UPIN
MANP0579Medicare ID - Type Unspecified