Provider Demographics
NPI:1871070375
Name:GOORCHENKO, MINDY LEIGH (APRN)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:LEIGH
Last Name:GOORCHENKO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 TUDOR CENTRE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5931
Mailing Address - Country:US
Mailing Address - Phone:907-561-8301
Mailing Address - Fax:
Practice Address - Street 1:3925 TUDOR CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5931
Practice Address - Country:US
Practice Address - Phone:907-561-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK133148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily