Provider Demographics
NPI:1104928878
Name:GOODMAN, TARYNA J (NP)
Entity type:Individual
Prefix:
First Name:TARYNA
Middle Name:J
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:496 SHOUP AVE W
Mailing Address - Street 2:SUITE E
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5043
Mailing Address - Country:US
Mailing Address - Phone:208-733-2885
Mailing Address - Fax:208-734-3352
Practice Address - Street 1:496 SHOUP AVE. W
Practice Address - Street 2:SUITE E
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5043
Practice Address - Country:US
Practice Address - Phone:208-733-2885
Practice Address - Fax:208-734-3352
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2013-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDNP-767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807733300Medicaid