Provider Demographics
NPI:1740761485
Name:GOODEN, TAMICHA ANDERSON (ARNP)
Entity type:Individual
Prefix:
First Name:TAMICHA
Middle Name:ANDERSON
Last Name:GOODEN
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E DIXIE AVE STE 805
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5994
Mailing Address - Country:US
Mailing Address - Phone:352-750-5001
Mailing Address - Fax:352-750-8401
Practice Address - Street 1:601 E DIXIE AVE STE 805
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5994
Practice Address - Country:US
Practice Address - Phone:352-750-5001
Practice Address - Fax:352-750-8401
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3327192163W00000X, 363LF0000X
FLME117251363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101150600Medicaid