| Doctor Name: | MR. JEREMY GOODRICH |
| NPI Number: | 1083832984 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN |
| License Number: | RN 9217803 |
| Business Practice Address: | 4343 Seminole St Starke, FL - 320919748 |
| Business Phone Number: | 3526034977 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1114, STARKE |
| State: | FL |
| Postal Code: | 320911114 |
| Phone Number: | 3526034977 |
| Fax Number: | |
| NPI Enumeration Date: | 04/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WE0003X |
| License Number: | RN 9217803 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Emergency |
| Taxonomy Definition: | |