1164906921 NPI number — MRS. CHRISTINA KNOTT WOOLFORD PA-C

Table of content: MRS. CHRISTINA KNOTT WOOLFORD PA-C (NPI 1164906921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164906921 NPI number — MRS. CHRISTINA KNOTT WOOLFORD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOLFORD
Provider First Name:
CHRISTINA
Provider Middle Name:
KNOTT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164906921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 947407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30394-7407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-917-2600
Provider Business Mailing Address Fax Number:
941-917-7884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 HEALTHCARE WAY UNIT 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH VENICE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34275-3670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-261-0160
Provider Business Practice Location Address Fax Number:
941-261-0165
Provider Enumeration Date:
09/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA9111594 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110271000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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