Active NPI
Ellie Goldense, LAT, ATC
- Athletic Trainer
- Hurlburt Field, FL
National Provider Identifier
1952982415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 004194
- Practice address
- 814 Tully St
Hurlburt Field, FL 32544-5744 - Phone
- (850) 312-8220
- NPI assigned
- Apr 16, 2021
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 004194 | NY | Primary |
Addresses
Primary practice location
814 Tully St
Hurlburt Field, FL 32544-5744
Mailing address
2004 98 Palms Blvd Unit 4221
Destin, FL 32541-2777
Phone (508) 259-9898
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618531200000",
"number": "1952982415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2004 98 PALMS BLVD UNIT 4221",
"city": "DESTIN",
"state": "FL",
"postal_code": "325412777",
"telephone_number": "508-259-9898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "814 TULLY ST",
"city": "HURLBURT FIELD",
"state": "FL",
"postal_code": "325445744",
"telephone_number": "850-312-8220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDENSE",
"first_name": "ELLIE",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-04-16",
"last_updated": "2021-04-16",
"certification_date": "2021-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "004194",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hurlburt Field, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.