MEDICARE: NICOLE WOODS PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1114587011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE WOODS PA-C

Provider Business Mailing Address
First Line	:	7255 OLD OAK BLVD BLDG C SUITE 405
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130
Country	:	US
Telephone Number	:	440-816-5830
Fax Number	:

Provider Business Practice Location Address
First Line	:	7255 OLD OAK BLVD BLDG C SUITE 405
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3331
Country	:	US
Telephone Number	:	440-816-5380
Fax Number	:

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

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	11/01/2022

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Directions to “ NICOLE WOODS PA-C” Practice Location

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