Provider Demographics
NPI:1669884748
Name:ANGELA M. GODWIN, NURSE PRACTITIONER IN FAMILY HEALTH, PLLC.
Entity type:Organization
Organization Name:ANGELA M. GODWIN, NURSE PRACTITIONER IN FAMILY HEALTH, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-457-8127
Mailing Address - Street 1:12001 AVALON LAKE DR APT 326
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7379
Mailing Address - Country:US
Mailing Address - Phone:646-457-8127
Mailing Address - Fax:347-824-2978
Practice Address - Street 1:1469 ASTOR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5846
Practice Address - Country:US
Practice Address - Phone:347-871-3774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335139-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty