Provider Demographics
NPI:1992459630
Name:WOODYARD, JOHN W
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:WOODYARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9505 49TH ST N APT 2-217
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-5288
Mailing Address - Country:US
Mailing Address - Phone:352-427-3905
Mailing Address - Fax:
Practice Address - Street 1:13575 58TH ST N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3740
Practice Address - Country:US
Practice Address - Phone:352-427-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist