=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457209066
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADELINE WOOD ANDERSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2026
-----------------------------------------------------
Last Update Date | 03/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4401 N HIMES AVE STE 175
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614-7095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-393-3800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2016 CLIFTON JOHNSTON CT
-----------------------------------------------------
City | NOLENSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37135-9606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-423-9359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------