Healthcare Provider Details

I. General information

NPI: 1417672726
Provider Name (Legal Business Name): WOODY GEORGES DNP, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 SHERIDAN ST STE A
HOLLYWOOD FL
33021-3546
US

IV. Provider business mailing address

6621 MAIN ST APT 2309
MIAMI LAKES FL
33014-2273
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-0040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11016350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: