MEDICARE: MRS. NE'TOSHA CENETRISE DOPSON-WOODALL PA

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	PA9101511	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356394522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NE'TOSHA CENETRISE DOPSON-WOODALL PA

Provider Business Mailing Address
First Line	:	9819 MARINE CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221-5616
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	949 LANE AVE S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-4706
Country	:	US
Telephone Number	:	888-831-2949
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/13/2023

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