MEDICARE: DEANNA ISABEL WOOD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	14915	FL

General Provider Information

NPI Number	:	1447737119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA ISABEL WOOD PA-C

Provider Business Mailing Address
First Line	:	13700 RICHMOND PARK DR N APT 202
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-4270
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13700 RICHMOND PARK DR N APT 202
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-4270
Country	:	US
Telephone Number	:	954-647-4057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	07/25/2018

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