Provider Demographics
NPI:1780827519
Name:GOFF, REBECCA A (APRN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:A
Last Name:GOFF
Suffix:
Gender:F
Credentials:APRN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 MADRID CT
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3046
Mailing Address - Country:US
Mailing Address - Phone:561-859-9334
Mailing Address - Fax:
Practice Address - Street 1:255 MADRID CT
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3046
Practice Address - Country:US
Practice Address - Phone:561-859-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3325872363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health