Provider Demographics
NPI:1831187012
Name:GODWIN, PIUS N (ARNP)
Entity type:Individual
Prefix:
First Name:PIUS
Middle Name:N
Last Name:GODWIN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W ALEXANDER ST STE 387
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-7155
Mailing Address - Country:US
Mailing Address - Phone:813-754-7756
Mailing Address - Fax:
Practice Address - Street 1:1267 TIMBERIDGE LOOP N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4682
Practice Address - Country:US
Practice Address - Phone:863-602-7908
Practice Address - Fax:863-815-1901
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1921112363L00000X
FLR78479363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR78479Medicare UPIN
FLY4841Medicare PIN