Healthcare Provider Details

I. General information

NPI: 1528668100
Provider Name (Legal Business Name): TARRAZ WOODRUFF RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2020
Last Update Date: 10/31/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UNIVERSITY RDG
GREENVILLE SC
29601-3635
US

IV. Provider business mailing address

772 RUNNING CREEK LN
BOILING SPRINGS SC
29316-6807
US

V. Phone/Fax

Practice location:
  • Phone: 864-282-4100
  • Fax:
Mailing address:
  • Phone: 864-590-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number214766
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: