Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | ARNP9189379 | FL |
NPI | 1073716650 |
---|---|
Provider Name | Mrs. Madetric Nafaye Wood |
First Address | Fort Pierce, FL 34951-2302 |
Second Address | Fort Pierce, FL 34951-2302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2007 |
Last Update Date | 27/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2078100 | (05) | FL |
AF163Z | MEDICARE LEGACY NUMBER (01) | FL |