Healthcare Provider Details

I. General information

NPI: 1811496862
Provider Name (Legal Business Name): TONIA MICHELE WOOD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 OLD EASTOVER RD
EASTOVER SC
29044-8303
US

IV. Provider business mailing address

PO BOX 3788
COLUMBIA SC
29230-3788
US

V. Phone/Fax

Practice location:
  • Phone: 803-353-8741
  • Fax: 803-353-8789
Mailing address:
  • Phone: 803-733-5969
  • Fax: 803-753-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number237664
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number21692
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21692
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: