Provider Demographics
NPI:1801119425
Name:GOODMAN, ALICE A (ARNP)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:A
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4469
Mailing Address - Country:US
Mailing Address - Phone:813-265-2100
Mailing Address - Fax:813-265-1788
Practice Address - Street 1:10010 N DALE MABRY HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4469
Practice Address - Country:US
Practice Address - Phone:813-265-2100
Practice Address - Fax:813-265-1788
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2639402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily