Provider Demographics
NPI:1851116370
Name:GOSS, MARVENA JOVETTE (RN)
Entity type:Individual
Prefix:MS
First Name:MARVENA
Middle Name:JOVETTE
Last Name:GOSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 WINDCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7937
Mailing Address - Country:US
Mailing Address - Phone:817-879-3851
Mailing Address - Fax:
Practice Address - Street 1:1600 WINDCASTLE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7937
Practice Address - Country:US
Practice Address - Phone:817-879-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA645298163WM0102X
TX753141163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn