Provider Demographics
NPI:1588114599
Name:WOODGEARD, ANDREA (FNP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WOODGEARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 WINDSOR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-2045
Mailing Address - Country:US
Mailing Address - Phone:419-630-8106
Mailing Address - Fax:
Practice Address - Street 1:932 WINDSOR LAKE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-2045
Practice Address - Country:US
Practice Address - Phone:419-630-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006629A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71006629AOtherINDIANA BOARD OF NURSING APN PRESCRIPTIVE AUTHORITY
IN71006629BOtherINDIANA BOARD OF NURSING CONTROLLED SUBSTANCE REGISTRATION