Provider Demographics
NPI:1326150020
Name:GOFF, MICHELLE LEE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:LEE
Last Name:GOFF
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:151 SOUTHHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:866-400-3376
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:27612 CASHFORD CIR STE 102
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6954
Practice Address - Country:US
Practice Address - Phone:866-400-3376
Practice Address - Fax:813-907-2706
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103771363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB564ZMedicare PIN