Provider Demographics
NPI:1851613723
Name:GOFF, GAIL R (CARE GIVER)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:R
Last Name:GOFF
Suffix:
Gender:F
Credentials:CARE GIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-4246
Mailing Address - Country:US
Mailing Address - Phone:954-639-7272
Mailing Address - Fax:
Practice Address - Street 1:321 SW 15TH ST
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-4246
Practice Address - Country:US
Practice Address - Phone:954-639-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG10029661607172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
172V00000XOtherHOME CARE