Healthcare Provider Details

I. General information

NPI: 1407921323
Provider Name (Legal Business Name): JOSHUA WOODIN P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463832 SR 200
YULEE FL
32097-3638
US

IV. Provider business mailing address

PO BOX 44004
JACKSONVILLE FL
32231-4004
US

V. Phone/Fax

Practice location:
  • Phone: 904-225-2311
  • Fax: 904-225-8481
Mailing address:
  • Phone: 904-376-3707
  • Fax: 904-225-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002962
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3715
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number101281
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003429
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: