Provider Demographics
NPI:1760729909
Name:GOODWIN, VICTORIA SUE (MSN, RN, ACNP-BC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SUE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MSN, RN, ACNP-BC
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:SUE
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, ACNP-BC
Mailing Address - Street 1:2424 DAKOTA DUNES CT
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5275
Mailing Address - Country:US
Mailing Address - Phone:512-284-2283
Mailing Address - Fax:
Practice Address - Street 1:12221 N MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:512-901-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX752605363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX296395YM8AMedicare PIN