MEDICARE: JACQUELINE ANN WOODS ARNP

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	363LA2200X	Adult Health Nurse Practitioner	1537482	FL

General Provider Information

NPI Number	:	1235126285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ANN WOODS ARNP

Provider Business Mailing Address
First Line	:	9640 NW 11TH ST
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-4846
Country	:	US
Telephone Number	:	954-474-7242
Fax Number	:

Provider Business Practice Location Address
First Line	:	3075 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4311
Country	:	US
Telephone Number	:	954-491-6200
Fax Number	:	954-491-6419

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	08/09/2010

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