Provider Demographics
NPI:1538580451
Name:GOGGINS, KATHRYN MARIE (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:GOGGINS
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:MARIE
Other - Last Name:LACALAMITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3227 S BISMARK LN APT 302
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8489
Mailing Address - Country:US
Mailing Address - Phone:954-464-5478
Mailing Address - Fax:
Practice Address - Street 1:4601 MILITARY TRL STE 203
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4835
Practice Address - Country:US
Practice Address - Phone:561-775-6011
Practice Address - Fax:561-775-6044
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9107529363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant