Provider Demographics
NPI:1841224482
Name:GODDARD, APRIL ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:APRIL
Middle Name:ANN
Last Name:GODDARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:APRIL
Other - Middle Name:ANN
Other - Last Name:TILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100214
Mailing Address - Street 2:1600 SW ARCHER RD
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0214
Mailing Address - Country:US
Mailing Address - Phone:352-273-9483
Mailing Address - Fax:352-392-3618
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:#100217
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0214
Practice Address - Country:US
Practice Address - Phone:352-273-9483
Practice Address - Fax:352-392-3618
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101109363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291675400Medicaid
FLE5899WMedicare PIN
FLP36469Medicare UPIN