Provider Demographics
NPI:1023036456
Name:WOOD, MICHAELINE E (FNP)
Entity Type:Individual
Prefix:MS
First Name:MICHAELINE
Middle Name:E
Last Name:WOOD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W RIO SALADO PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-3812
Mailing Address - Country:US
Mailing Address - Phone:480-480-8330
Mailing Address - Fax:480-610-6189
Practice Address - Street 1:4710 N HABANA AVE STE 107
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7143
Practice Address - Country:US
Practice Address - Phone:813-910-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO126546363LF0000X
FLAPRN11021590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425139912Medicaid
FL119709400Medicaid
MO114010181Medicare PIN
MO114010181Medicaid