Provider Demographics
NPI:1598877672
Name:GOULD, PATRICIA GRASSMAN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:GRASSMAN
Last Name:GOULD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:785 PRIMERA BLVD STE 1031
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2124
Mailing Address - Country:US
Mailing Address - Phone:407-834-8111
Mailing Address - Fax:407-834-8506
Practice Address - Street 1:785 PRIMERA BLVD STE 1031
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2124
Practice Address - Country:US
Practice Address - Phone:407-834-8111
Practice Address - Fax:407-834-8506
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166736176B00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife