Provider Demographics
NPI:1376335273
Name:GOODWIN, JANA LYNN (APN)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:LYNN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:LYNN
Other - Last Name:HURDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:8940 N WOOD SAGE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7822
Mailing Address - Country:US
Mailing Address - Phone:309-243-0003
Mailing Address - Fax:309-243-3274
Practice Address - Street 1:8940 N WOOD SAGE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7822
Practice Address - Country:US
Practice Address - Phone:309-243-0003
Practice Address - Fax:309-243-3274
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209032345363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner