Active NPI
Sandra Goodman
- Nursing Care Agency
- Port St Lucie, FL
National Provider Identifier
1790977064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Care Agency
- License
- RN 9241725
- Practice address
- 1425 SE San Sovina Ter
Port St Lucie, FL 34952-5727 - Phone
- (772) 919-5592
- NPI assigned
- Aug 10, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Care Agency | 251J00000X | RN 9241725 | FL | Primary |
Addresses
Primary practice location
1425 SE San Sovina Ter
Port St Lucie, FL 34952-5727
Mailing address
1425 SE San Sovina Ter
Port St Lucie, FL 34952-5727
Phone (772) 919-5592
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN 9241725 | FL | MD | Nursing Care Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186704000000",
"number": "1790977064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1425 SE SAN SOVINA TER",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349525727",
"telephone_number": "772-919-5592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1425 SE SAN SOVINA TER",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349525727",
"telephone_number": "772-919-5592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMAN",
"first_name": "SANDRA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-10",
"last_updated": "2007-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "251J00000X",
"taxonomy_group": "",
"desc": "Nursing Care",
"state": "FL",
"license": "RN 9241725",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.