Provider Demographics
NPI:1891760872
Name:GOSHOW, JENNIFER JACOBSON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JACOBSON
Last Name:GOSHOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1055 CASON LN
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-6743
Mailing Address - Country:US
Mailing Address - Phone:615-895-1285
Mailing Address - Fax:
Practice Address - Street 1:1420 W BADDOUR PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1510
Practice Address - Country:US
Practice Address - Phone:615-453-3645
Practice Address - Fax:615-453-2675
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS50144Medicare UPIN