Provider Demographics
NPI:1295771590
Name:WOODWARD, KATIE A (ARNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 E ALTAMONTE DR
Mailing Address - Street 2:SUITE 318
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701
Mailing Address - Country:US
Mailing Address - Phone:407-834-8111
Mailing Address - Fax:407-834-8506
Practice Address - Street 1:661 E ALTAMONTE DR
Practice Address - Street 2:SUITE 318
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:407-834-8111
Practice Address - Fax:407-834-8506
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9172674207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P95986Medicare UPIN
U1124YMedicare ID - Type Unspecified
24039Medicare ID - Type Unspecified