Provider Demographics
NPI:1063992097
Name:WOOD, SAMUEL LAWRENCE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LAWRENCE
Last Name:WOOD
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 DOWELL SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2453
Mailing Address - Country:US
Mailing Address - Phone:865-314-5939
Mailing Address - Fax:865-297-5233
Practice Address - Street 1:1340 DOWELL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2453
Practice Address - Country:US
Practice Address - Phone:865-314-5939
Practice Address - Fax:865-297-5233
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily