Healthcare Provider Details

I. General information

NPI: 1538909486
Provider Name (Legal Business Name): TRISTIN WOODRUFF PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16704 HAWFIELD WAY DR
CHARLOTTE NC
28277-6132
US

IV. Provider business mailing address

16704 HAWFIELD WAY DR
CHARLOTTE NC
28277-6132
US

V. Phone/Fax

Practice location:
  • Phone: 704-337-0221
  • Fax:
Mailing address:
  • Phone: 704-337-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9118849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: