Provider Demographics
NPI:1558092494
Name:GOFF, JENNA MARIE (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:MARIE
Last Name:GOFF
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 GREENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-5223
Mailing Address - Country:US
Mailing Address - Phone:321-848-8247
Mailing Address - Fax:
Practice Address - Street 1:280 N SYKES CREEK PKWY STE A
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3491
Practice Address - Country:US
Practice Address - Phone:321-452-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020348363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily