Provider Demographics
NPI:1972067155
Name:REBECCA A. GOFF APRN, IBCLC, LLC
Entity Type:Organization
Organization Name:REBECCA A. GOFF APRN, IBCLC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, IBCLC
Authorized Official - Phone:561-859-9334
Mailing Address - Street 1:255 MADRID CT
Mailing Address - Street 2:
Mailing Address - City:MERRITT IS
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3046
Mailing Address - Country:US
Mailing Address - Phone:561-859-9334
Mailing Address - Fax:
Practice Address - Street 1:255 MADRID CT
Practice Address - Street 2:
Practice Address - City:MERRITT IS
Practice Address - State:FL
Practice Address - Zip Code:32953-3046
Practice Address - Country:US
Practice Address - Phone:561-859-9334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty