Provider Demographics
NPI:1598757163
Name:GOSHORN, CATHERINE (PA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:GOSHORN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BROTHER GEENEN WAY
Mailing Address - Street 2:SENIOR FRIENDSHIP CENTERS, INC.
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7102
Mailing Address - Country:US
Mailing Address - Phone:941-556-3215
Mailing Address - Fax:941-955-8214
Practice Address - Street 1:1900 BROTHER GEENEN WAY
Practice Address - Street 2:SENIOR FRIENDSHIP CENTERS, INC.
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7102
Practice Address - Country:US
Practice Address - Phone:941-556-3215
Practice Address - Fax:941-955-8214
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101845363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA 9101845OtherFLORIDA LICENSE
FL293089700Medicaid
FL293089700Medicaid