Provider Demographics
NPI:1134148521
Name:GOFORTH, JENNIFER MARIE (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:GOFORTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:GOFORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:900 THARP RD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-9159
Mailing Address - Country:US
Mailing Address - Phone:530-844-5655
Mailing Address - Fax:530-821-2030
Practice Address - Street 1:900 THARP RD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-9159
Practice Address - Country:US
Practice Address - Phone:530-844-5655
Practice Address - Fax:530-821-2030
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10602363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10602OtherLICENSE