Provider Demographics
NPI:1720638083
Name:GODWIN, VELMA
Entity Type:Individual
Prefix:
First Name:VELMA
Middle Name:
Last Name:GODWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 59TH AVENUE DR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-5403
Mailing Address - Country:US
Mailing Address - Phone:941-720-7421
Mailing Address - Fax:
Practice Address - Street 1:3420 59TH AVENUE DR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-5403
Practice Address - Country:US
Practice Address - Phone:941-720-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider