Provider Demographics
NPI:1184679300
Name:GOOLD, CHRISTINE ANNE (FNP/PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANNE
Last Name:GOOLD
Suffix:
Gender:F
Credentials:FNP/PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 PRATO ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7119
Mailing Address - Country:US
Mailing Address - Phone:925-522-1093
Mailing Address - Fax:
Practice Address - Street 1:5144 HILL RD E
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-6300
Practice Address - Country:US
Practice Address - Phone:707-263-8955
Practice Address - Fax:707-263-8340
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17490363A00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q28476Medicare UPIN