Provider Demographics
NPI:1811993587
Name:GOFF, JILL ANNE (CNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANNE
Last Name:GOFF
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W WENGER RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2722
Mailing Address - Country:US
Mailing Address - Phone:937-771-5100
Mailing Address - Fax:937-832-3014
Practice Address - Street 1:20 W WENGER RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2722
Practice Address - Country:US
Practice Address - Phone:937-771-5100
Practice Address - Fax:937-832-3014
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01698-NP363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2479250Medicaid
OH2479250Medicaid
OHH154410Medicare PIN