Provider Demographics
NPI:1326802067
Name:WOODS, ZACHARY DESMOND (AGNP-C)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:DESMOND
Last Name:WOODS
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 OLD BAINBRIDGE RD APT 1712
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-3597
Mailing Address - Country:US
Mailing Address - Phone:850-228-6117
Mailing Address - Fax:
Practice Address - Street 1:2677 OLD BAINBRIDGE RD APT 1712
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-3597
Practice Address - Country:US
Practice Address - Phone:850-228-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031210363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care