Provider Demographics
NPI:1679193601
Name:GOLDA, JESSICA ROBIN (RN, BSN, CPEN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROBIN
Last Name:GOLDA
Suffix:
Gender:F
Credentials:RN, BSN, CPEN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ROBIN
Other - Last Name:DIMINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:9981 S HEALTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3618
Mailing Address - Country:US
Mailing Address - Phone:239-343-6210
Mailing Address - Fax:
Practice Address - Street 1:9981 S HEALTHPARK DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3618
Practice Address - Country:US
Practice Address - Phone:239-343-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9415496163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse