Provider Demographics
NPI:1376541334
Name:WOODS, ANDREA C (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:WOODS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12438
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-2438
Mailing Address - Country:US
Mailing Address - Phone:727-365-7371
Mailing Address - Fax:727-865-0078
Practice Address - Street 1:6316 BAHAMA SHORES DR S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-5438
Practice Address - Country:US
Practice Address - Phone:727-365-7371
Practice Address - Fax:727-865-0078
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT66167207R00000X
FLME0049198174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51885Medicare UPIN
FL07248AMedicare ID - Type Unspecified