MEDICARE: MRS. MADETRIC NAFAYE WOOD APRN-BC, GNP

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
1	163W00000X	Registered Nurse	RN9189379	FL
2	363LG0600X	Gerontology Nurse Practitioner	ARNP9189379	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	AF163Z	OTHER	FL	MEDICARE LEGACY NUMBER

Other Identifiers

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

General Provider Information

NPI Number	:	1073716650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MADETRIC NAFAYE WOOD APRN-BC, GNP

Provider Business Mailing Address
First Line	:	5804 INDIAN PINES BLVD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-2302
Country	:	US
Telephone Number	:	772-828-3752
Fax Number	:	772-302-3518

Provider Business Practice Location Address
First Line	:	5804 INDIAN PINES BLVD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-2302
Country	:	US
Telephone Number	:	772-828-3752
Fax Number	:	772-302-3518

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2007
Last Update Date	:	09/29/2022

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