Provider Demographics
NPI:1548602691
Name:GOSSELIN, DAVID N (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:N
Last Name:GOSSELIN
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5229
Mailing Address - Country:US
Mailing Address - Phone:912-283-7118
Mailing Address - Fax:912-283-7132
Practice Address - Street 1:305 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5229
Practice Address - Country:US
Practice Address - Phone:912-283-7118
Practice Address - Fax:912-283-7132
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230020363LA2200X
FLARNP3174172363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20-4363143OtherORTHOPEDIC SURGERY AND SPORTS MEDICINE-MAYO CLINIC HEALTH SYSTEM WAYCROSS