Healthcare Provider Details

I. General information

NPI: 1780030544
Provider Name (Legal Business Name): TONYA MARIE WOODS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONYA MARIE MARSTELLER MS

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

762 SCRUB JAY DR
ST AUGUSTINE FL
32092-1729
US

IV. Provider business mailing address

2220 COUNTY ROAD 210 W STE 108-313
JACKSONVILLE FL
32259-4058
US

V. Phone/Fax

Practice location:
  • Phone: 904-446-8428
  • Fax: 844-770-0422
Mailing address:
  • Phone: 904-446-8428
  • Fax: 844-770-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH002795
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: