Provider Demographics
NPI:1598231979
Name:WOOD, SHANA BROOKE (ARNP)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:BROOKE
Last Name:WOOD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:WOOD
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:946 RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3333 CAPITAL OAKS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4513
Practice Address - Country:US
Practice Address - Phone:850-431-4470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9287365363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health