Provider Demographics
NPI:1942946363
Name:GOODSON, CAROLYN (APRN, NNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:GOODSON
Suffix:
Gender:F
Credentials:APRN, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 SE EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-4713
Mailing Address - Country:US
Mailing Address - Phone:772-214-5983
Mailing Address - Fax:
Practice Address - Street 1:431 SE EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-4713
Practice Address - Country:US
Practice Address - Phone:772-214-5983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2037882163WN0002X
FLNA363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care