Healthcare Provider Details

I. General information

NPI: 1508154956
Provider Name (Legal Business Name): TAMARA MICHELLE WOOD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E ST NW L209
WASHINGTON DC
20520-5712
US

IV. Provider business mailing address

4437 MAGILL RD
JACKSONVILLE FL
32219-4800
US

V. Phone/Fax

Practice location:
  • Phone: 202-663-1779
  • Fax:
Mailing address:
  • Phone: 904-349-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA200001678
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 9106033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: