Provider Demographics
NPI:1265760284
Name:GOFTON, JEREMY E (RNFA)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:E
Last Name:GOFTON
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 E CAMINO DEL CELADOR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1824
Mailing Address - Country:US
Mailing Address - Phone:520-979-9178
Mailing Address - Fax:
Practice Address - Street 1:5601 E CAMINO DEL CELADOR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-1824
Practice Address - Country:US
Practice Address - Phone:520-979-9178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO125349163WR0006X
AZRN139696163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant