Healthcare Provider Details

I. General information

NPI: 1730633967
Provider Name (Legal Business Name): ELEANOR H. G. WOOD PA, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 SE SALERNO RD STE 110
STUART FL
34997-6572
US

IV. Provider business mailing address

2150 SE SALERNO RD STE 110
STUART FL
34997-6572
US

V. Phone/Fax

Practice location:
  • Phone: 772-781-2735
  • Fax: 772-781-2739
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110006496
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117248
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: