Provider Demographics
NPI:1487047031
Name:WOOD, NICOLE K (MS, CGC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:K
Last Name:WOOD
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SOUTH TAMIAMI TRAIL
Mailing Address - Street 2:ATTN: GENETIC EDUCATION DEPARTMENT
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239
Mailing Address - Country:US
Mailing Address - Phone:941-917-2166
Mailing Address - Fax:941-917-2629
Practice Address - Street 1:1700 SOUTH TAMIAMI TRAIL
Practice Address - Street 2:ATTN: GENETIC EDUCATION DEPARTMENT
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-917-2166
Practice Address - Fax:941-917-2629
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC222170300000X
170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS