Provider Demographics
NPI:1770521874
Name:GODDARD, DEBORAH JEAN (ARNP)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JEAN
Last Name:GODDARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 N BYRON BUTLER PKWY
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2315
Mailing Address - Country:US
Mailing Address - Phone:850-223-5400
Mailing Address - Fax:850-223-5401
Practice Address - Street 1:300 HEALTH PARK BLVD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3707
Practice Address - Country:US
Practice Address - Phone:904-819-4747
Practice Address - Fax:904-819-5080
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3353562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306983400Medicaid