Provider Demographics
NPI:1811612609
Name:GODWIN, IVY LANCASTER (FNP)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:LANCASTER
Last Name:GODWIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MCKENTSON LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-5654
Mailing Address - Country:US
Mailing Address - Phone:229-412-0643
Mailing Address - Fax:
Practice Address - Street 1:33 MCKENTSON LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-5654
Practice Address - Country:US
Practice Address - Phone:229-412-0643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily