Basic Information
| Provider Information | |||||||||
| NPI: | 1598757163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOSHORN | ||||||||
| FirstName: | CATHERINE | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 BROTHER GEENEN WAY | ||||||||
| Address2: | SENIOR FRIENDSHIP CENTERS, INC. | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342367102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9415563215 | ||||||||
| FaxNumber: | 9419558214 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 BROTHER GEENEN WAY | ||||||||
| Address2: | SENIOR FRIENDSHIP CENTERS, INC. | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342367102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9415563215 | ||||||||
| FaxNumber: | 9419558214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 08/21/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9101845 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | PA 9101845 | 01 | FL | FLORIDA LICENSE | OTHER | 293089700 | 05 | FL | MEDICAID |