Provider Demographics
NPI:1619773926
Name:GOODWIN, KOREY ANN
Entity type:Individual
Prefix:
First Name:KOREY
Middle Name:ANN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6279 WHITTLE CT
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-6104
Mailing Address - Country:US
Mailing Address - Phone:919-741-7059
Mailing Address - Fax:
Practice Address - Street 1:6279 WHITTLE CT
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-6104
Practice Address - Country:US
Practice Address - Phone:919-741-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN-5251167164W00000X
FLA3269920171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No164W00000XNursing Service ProvidersLicensed Practical Nurse