Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 2935672 | FL |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN2935672 | FL |
NPI | 1003397944 |
---|---|
Provider Name | Andrea Annmarie Goulbourne-Smith |
First Address | Oakland Park, FL 33334-4400 |
Second Address | Hollywood, FL 33024-2708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2018 |
Last Update Date | 10/02/2021 |