Individual
LINDA BERGIN GOFORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2001 MANATEE AVE E, SUITE 103, BRADENTON, FL 34208-1620
(941) 803-8395
(941) 803-8158
Mailing address
2001 MANATEE AVENUE EAST,, SUITE 103, BRADENTON, FL 34208
(941) 803-8395
(941) 803-8158
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
102514
NC
363AM0700X
Medical Physician Assistant
Primary
PA9106347
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MB0350710
CONTROLLED SUBSTANCE REGI
NC
Enumeration date
10/10/2006
Last updated
04/04/2012
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