Provider Demographics
NPI:1831345974
Name:GOODSON, HEATHER MELISSA (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MELISSA
Last Name:GOODSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CARILLON PKWY
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1115
Mailing Address - Country:US
Mailing Address - Phone:727-573-5626
Mailing Address - Fax:727-573-5627
Practice Address - Street 1:900 CARILLON PKWY
Practice Address - Street 2:SUITE 311
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1115
Practice Address - Country:US
Practice Address - Phone:727-573-5626
Practice Address - Fax:727-573-5627
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9104621363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant