Healthcare Provider Details

I. General information

NPI: 1174855381
Provider Name (Legal Business Name): JOHNNITA WOODS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 W 110TH ST APT 1E
NEW YORK NY
10025-2021
US

IV. Provider business mailing address

535 W 110TH ST APT 1E
NEW YORK NY
10025-2021
US

V. Phone/Fax

Practice location:
  • Phone: 212-280-4740
  • Fax: 212-280-4743
Mailing address:
  • Phone: 212-280-4740
  • Fax: 212-280-4743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15520000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF358168-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: