Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 1009922 | FL |
NPI | 1033111943 |
---|---|
Provider Name | Ms. Janet Lee Goshorn |
First Address | Clermont, FL 34714-8323 |
Second Address | Orlando, FL 32803-1248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 15/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
302786400 | (05) | FL |
S94707 | (02) | FL |