Healthcare Provider Details

I. General information

NPI: 1528640216
Provider Name (Legal Business Name): NANCY COLEEN WOODRUFF CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E GOVERNMENT ST
PENSACOLA FL
32502-6136
US

IV. Provider business mailing address

600 E GOVERNMENT ST
PENSACOLA FL
32502-6136
US

V. Phone/Fax

Practice location:
  • Phone: 850-500-7527
  • Fax: 850-855-4030
Mailing address:
  • Phone: 850-500-7527
  • Fax: 850-855-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: