Healthcare Provider Details

I. General information

NPI: 1134226269
Provider Name (Legal Business Name): TINA MARIE WOODBY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA MARIE NOLEN

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 6TH ST SUITE 205 GULF COAST REGIONAL MEDICAL CENTER
PANAMA CITY FL
32405
US

IV. Provider business mailing address

1613 NORTH HARRISON PARKWAY SUITE 200, MAILSTOP SH 9
SUNRISE FL
33323
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-8341
  • Fax: 954-851-1746
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-616-3879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3027672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: