Healthcare Provider Details

I. General information

NPI: 1952763187
Provider Name (Legal Business Name): ALYSSA WOODARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2016
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 DAVIS BLVD
TAMPA FL
33606-3475
US

IV. Provider business mailing address

17 DAVIS BLVD
TAMPA FL
33606-3475
US

V. Phone/Fax

Practice location:
  • Phone: 813-821-8700
  • Fax: 813-821-8332
Mailing address:
  • Phone: 813-821-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME139208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: