Individual
MARY LISA GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1807 SHORT BRANCH DR STE 102, NEW PORT RICHEY, FL 34655-4424
(727) 376-3547
Mailing address
4404 W BALLAST POINT BLVD, TAMPA, FL 33611-5602
(813) 895-4727
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
11014405
FL
Other
Enumeration date
07/29/2021
Last updated
07/29/2021
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