Individual
BRENDA GOODING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2789 ORTIZ AVE, FORT MYERS, FL 33905-7806
(239) 275-3222
Mailing address
3763 EVANS AVE, FORT MYERS, FL 33901-9302
(239) 275-3222
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5203582
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G352071649070
DRIVERS LISCENSE
FL
Enumeration date
03/24/2016
Last updated
03/24/2016
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