Healthcare Provider Details

I. General information

NPI: 1629362199
Provider Name (Legal Business Name): MILDRED SUE WOODRUFF APRN, BSN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 DELAWARE AVE
FORT PIERCE FL
34950-3975
US

IV. Provider business mailing address

1505 DELAWARE AVE
FORT PIERCE FL
34950-3975
US

V. Phone/Fax

Practice location:
  • Phone: 772-461-1402
  • Fax: 561-847-2306
Mailing address:
  • Phone: 772-461-1402
  • Fax: 561-847-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9244530
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0038371
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number3006942
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28196047A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: