MEDICARE: PATRICE WOO WADSWORTH 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	363L00000X	Nurse Practitioner	APRN9204512	FL
2	363LF0000X	Family Nurse Practitioner	2007001598	FL
3	363LF0000X	Family Nurse Practitioner	ARNP9204512	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

General Provider Information

NPI Number	:	1760609960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE WOO WADSWORTH ARNP

Provider Business Mailing Address
First Line	:	280 8TH TER
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-2836
Country	:	US
Telephone Number	:	772-770-2311
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 37TH PL
Second Line	:	SUITE 105
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6586
Country	:	US
Telephone Number	:	772-299-1901
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	12/09/2019

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