Provider Demographics
NPI:1790958221
Name:COOK, JOANN GOFF (APRN WHNP BC)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:GOFF
Last Name:COOK
Suffix:
Gender:F
Credentials:APRN WHNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 LEE AVENUE
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794
Mailing Address - Country:US
Mailing Address - Phone:229-386-1528
Mailing Address - Fax:229-388-0556
Practice Address - Street 1:1806 LEE AVENUE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794
Practice Address - Country:US
Practice Address - Phone:229-386-1528
Practice Address - Fax:229-388-0556
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN072673NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner