Provider Demographics
NPI:1215920731
Name:GOODWIN, AUBREY CHRISTINE (NP)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:CHRISTINE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:CHRISTINE
Other - Last Name:PAQUIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19450 DEERFIELD AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6820
Mailing Address - Country:US
Mailing Address - Phone:703-723-7337
Mailing Address - Fax:703-723-6848
Practice Address - Street 1:19450 DEERFIELD AVE
Practice Address - Street 2:STE 200
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6820
Practice Address - Country:US
Practice Address - Phone:703-723-7337
Practice Address - Fax:703-723-6848
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165375363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7793677Medicaid
VA7793677Medicaid
P78442Medicare UPIN