Provider Demographics
NPI:1669772406
Name:GOLDWIRE, HERBERT (ARNP)
Entity type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:
Last Name:GOLDWIRE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11216 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7957
Mailing Address - Country:US
Mailing Address - Phone:954-681-2881
Mailing Address - Fax:
Practice Address - Street 1:1550 MADRUGA AVE STE 406
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3019
Practice Address - Country:US
Practice Address - Phone:954-681-2881
Practice Address - Fax:305-740-8103
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9207809363LP2300X
FLAPRN9207809363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEQ183AMedicare PIN