Provider Demographics
NPI:1962867028
Name:WARD, JODIE (APN)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 KELCEY CT STE 103
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5986
Mailing Address - Country:US
Mailing Address - Phone:850-352-0351
Mailing Address - Fax:850-297-0352
Practice Address - Street 1:305 DOVER RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-4157
Practice Address - Country:US
Practice Address - Phone:931-552-6722
Practice Address - Fax:931-552-6979
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11002406363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner