Provider Demographics
NPI:1669650156
Name:GOODWIN, IMANI CAROLYN (PHD, RN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:IMANI
Middle Name:CAROLYN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PHD, RN, FNP-BC
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP-BC
Mailing Address - Street 1:100 BALDWIN DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-5058
Mailing Address - Country:US
Mailing Address - Phone:334-790-2651
Mailing Address - Fax:
Practice Address - Street 1:4680 US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446
Practice Address - Country:US
Practice Address - Phone:334-790-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9335545363LF0000X
AL1-046688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily