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NPI Code Detail

MEDICARE: MS. MICHAELINE E WOOD FNP

MEDICARE: MS. MICHAELINE E WOOD FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner126546MO
2363LF0000XFamily Nurse PractitionerAPRN11021590FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023036456
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHAELINE E WOOD FNP
Provider Business Mailing Address
First Line : 850 W RIO SALADO PKWY STE 201
Second Line :
City : TEMPE
State : AZ
Zip : 85281-3812
Country : US
Telephone Number : 480-480-8330
Fax Number : 480-610-6189
Provider Business Practice Location Address
First Line : 4710 N HABANA AVE STE 107
Second Line :
City : TAMPA
State : FL
Zip : 33614-7143
Country : US
Telephone Number : 813-910-0030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 12/20/2023

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