Provider Demographics
NPI:1356626741
Name:WOODRUFF, JOLANA R (PA-C)
Entity Type:Individual
Prefix:
First Name:JOLANA
Middle Name:R
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2348 W SWIFT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-1250
Mailing Address - Country:US
Mailing Address - Phone:559-224-2544
Mailing Address - Fax:
Practice Address - Street 1:2348 W SWIFT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-1250
Practice Address - Country:US
Practice Address - Phone:559-224-2544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant