Provider Demographics
NPI:1073716650
Name:WOOD, MADETRIC NAFAYE (APRN-BC, GNP)
Entity Type:Individual
Prefix:MRS
First Name:MADETRIC
Middle Name:NAFAYE
Last Name:WOOD
Suffix:
Gender:F
Credentials:APRN-BC, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5804 INDIAN PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951-2302
Mailing Address - Country:US
Mailing Address - Phone:772-828-3752
Mailing Address - Fax:772-302-3518
Practice Address - Street 1:5804 INDIAN PINES BLVD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-2302
Practice Address - Country:US
Practice Address - Phone:772-828-3752
Practice Address - Fax:772-302-3518
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9189379163W00000X
FLARNP9189379363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2078100Medicaid
FLAF163ZOtherMEDICARE LEGACY NUMBER