Provider Demographics
NPI:1306242276
Name:WOINOSKI, NADINE MARIE
Entity type:Individual
Prefix:MS
First Name:NADINE
Middle Name:MARIE
Last Name:WOINOSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 SLASH PINE CIR
Mailing Address - Street 2:#124
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-2292
Mailing Address - Country:US
Mailing Address - Phone:941-286-8897
Mailing Address - Fax:
Practice Address - Street 1:3049 CLEVELAND AVE
Practice Address - Street 2:SUITE 269
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7041
Practice Address - Country:US
Practice Address - Phone:703-424-0354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1073871208251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011132100Medicaid