Provider Demographics
NPI:1861679227
Name:GOODWIN, NANCY J (DO)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12260 TAMIAMI TRL E STE 102
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-7937
Mailing Address - Country:US
Mailing Address - Phone:954-274-9332
Mailing Address - Fax:
Practice Address - Street 1:12260 TAMIAMI TRL E STE 102
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113
Practice Address - Country:US
Practice Address - Phone:954-274-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11292207PE0004X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS11292OtherMEDICAL LICENSE