Provider Demographics
NPI:1992265185
Name:SMITH WOODS, TAMMY (LPN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:SMITH WOODS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 FORT CAROLINE RD APT 1702
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-1842
Mailing Address - Country:US
Mailing Address - Phone:904-233-0394
Mailing Address - Fax:
Practice Address - Street 1:5959 FORT CAROLINE RD APT 1702
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-1842
Practice Address - Country:US
Practice Address - Phone:904-322-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5183210164W00000X
251J00000X, 253Z00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5183210OtherLPN