Provider Demographics
NPI:1427305127
Name:GOAS, CLARISSE JUSTINE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:CLARISSE
Middle Name:JUSTINE
Last Name:GOAS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:CLARISSE
Other - Middle Name:JUSTINE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-4969
Mailing Address - Fax:614-366-2210
Practice Address - Street 1:480 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1229
Practice Address - Country:US
Practice Address - Phone:614-293-4969
Practice Address - Fax:614-366-2210
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.13676363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0072301Medicaid