1669884748 NPI number — ANGELA M. GODWIN, NURSE PRACTITIONER IN FAMILY HEALTH, PLLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669884748 NPI number — ANGELA M. GODWIN, NURSE PRACTITIONER IN FAMILY HEALTH, PLLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELA M. GODWIN, NURSE PRACTITIONER IN FAMILY HEALTH, PLLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669884748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12001 AVALON LAKE DR APT 326
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32828-7379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-457-8127
Provider Business Mailing Address Fax Number:
347-824-2978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1469 ASTOR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10469-5846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-871-3774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
646-457-8127

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F335139-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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