Healthcare Provider Details

I. General information

NPI: 1215215819
Provider Name (Legal Business Name): TAMMY LYNN WOOD M.S. PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2011
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CORLIES AVE SUITE 12
NEPTUNE NJ
07753-6102
US

IV. Provider business mailing address

1945 STATE ROUTE 33
NEPTUNE NJ
07753-4859
US

V. Phone/Fax

Practice location:
  • Phone: 732-263-7960
  • Fax: 732-263-7961
Mailing address:
  • Phone: 732-413-3626
  • Fax: 732-776-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00317700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: