Provider Demographics
NPI:1184684813
Name:WOODRUFF, DARREN S (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:S
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6508 SMOOTH THORN CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5498
Mailing Address - Country:US
Mailing Address - Phone:904-635-0696
Mailing Address - Fax:
Practice Address - Street 1:6508 SMOOTH THORN CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5498
Practice Address - Country:US
Practice Address - Phone:904-635-0696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3287542367500000X
IL209-007515367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3074692-00Medicaid
GA323085240AMedicaid
FL3074692-00Medicaid
GA323085240AMedicaid
ILPENDINGMedicare PIN