Provider Demographics
NPI:1326399809
Name:WOODCOCK, JACQUELINE NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:NICOLE
Last Name:WOODCOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:35 BILL FRIES DR
Mailing Address - Street 2:BLDG L
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2730
Mailing Address - Country:US
Mailing Address - Phone:843-342-4455
Mailing Address - Fax:843-342-4435
Practice Address - Street 1:35 BILL FRIES DR
Practice Address - Street 2:BLDG L
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2730
Practice Address - Country:US
Practice Address - Phone:843-342-4455
Practice Address - Fax:843-342-4435
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC2714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2714OtherNPI 1326399809