Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | PT 16192 | FL |
NPI | 1245298975 |
---|---|
Provider Name | Heidi Goff |
First Address | Winter Springs, FL 32708-5186 |
Second Address | Winter Springs, FL 32708-5186 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 13/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
681637196 | (05) | FL |
886448900 | (05) | FL |