Healthcare Provider Details

I. General information

NPI: 1992265185
Provider Name (Legal Business Name): TAMMY SMITH WOODS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 11/13/2021
Certification Date: 11/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 FORT CAROLINE RD APT 1702
JACKSONVILLE FL
32277-1842
US

IV. Provider business mailing address

5959 FORT CAROLINE RD APT 1702
JACKSONVILLE FL
32277-1842
US

V. Phone/Fax

Practice location:
  • Phone: 904-322-4351
  • Fax:
Mailing address:
  • Phone: 904-233-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number5183210
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: