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Individual
TINA GOODPASTURE
Active
Individual
TINA GOODPASTURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5004054
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230159
MEDICARE
NC
05
—
8901685
—
NC
Enumeration date
08/29/2008
Last updated
08/18/2021
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