Provider Demographics
NPI:1548756505
Name:GOGOL, ARICA LYNNE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ARICA
Middle Name:LYNNE
Last Name:GOGOL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 LAWAI RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-2522
Mailing Address - Country:US
Mailing Address - Phone:419-290-8612
Mailing Address - Fax:
Practice Address - Street 1:1119 N MILITARY HWY
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2415
Practice Address - Country:US
Practice Address - Phone:757-240-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0037562207Q00000X
VA0024176261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily