Provider Demographics
NPI:1396452389
Name:WOODARD, TIARA NICOLE (FNP, APRN)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:NICOLE
Last Name:WOODARD
Suffix:
Gender:F
Credentials:FNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 HOLCOMB BRIDGE RD STE 200A&B
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-7156
Mailing Address - Country:US
Mailing Address - Phone:470-275-4993
Mailing Address - Fax:
Practice Address - Street 1:3475 HOLCOMB BRIDGE RD STE 200A&B
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-7156
Practice Address - Country:US
Practice Address - Phone:470-275-4993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN273255163WM0705X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical