Provider Demographics
NPI:1093472862
Name:WOODY, ANNA LEE (APRN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LEE
Last Name:WOODY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5390 FRUITPORT ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-2432
Mailing Address - Country:US
Mailing Address - Phone:321-480-3219
Mailing Address - Fax:
Practice Address - Street 1:5390 FRUITPORT ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-2432
Practice Address - Country:US
Practice Address - Phone:321-480-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016783363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care