Mary Lisa Goodman, NURSE PRACTITIONER

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

11014405 Issued in FL

Practice address

1807 Short Branch Dr Ste 102
New Port Richey, FL 34655-4424

Phone

(727) 376-3547

NPI assigned

Jul 29, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Trinity Family and Sports Medicine PA

  • Sports Medicine (Family Medicine) Physician
  • Trinity, FL
  • NPI 1891991238
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627516800000",
    "number": "1265105803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4404 W BALLAST POINT BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336115602",
            "telephone_number": "813-895-4727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 SHORT BRANCH DR STE 102",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346554424",
            "telephone_number": "727-376-3547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "MARY",
        "middle_name": "LISA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-29",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "11014405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Javier R Gonzalez, DO
• Nagabis Gonzalez, D.M.D.
• Sara Gonzalez
• Celeste Ray Goodman, LCSW
• Donald Goodman, PTA
• Jamelyn Goodpaster, DDS
• Brittany Nicole Goodwin, PHD
• Robert Paul Goodwin, PHARMACIST
• Gary Goodworth, PHD
• Theresa Gooldrup, M.ED., SLP

• Adult Health Nurse Practitioner in New Port Richey, FL
• Providers in New Port Richey, FL by specialty
• Adult Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.