Provider Demographics
NPI:1902213770
Name:GOODSON, TONYA (ARNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:GOODSON
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 SINGER RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32466-4520
Mailing Address - Country:US
Mailing Address - Phone:407-782-9907
Mailing Address - Fax:
Practice Address - Street 1:4896 HIGHWAY 90 STE A
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-7840
Practice Address - Country:US
Practice Address - Phone:850-526-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9314865363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01412627OtherRR MEDICARE
FLP01412627OtherRR MEDICARE