Provider Demographics
NPI:1568480101
Name:WOODARD, JANICE W (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:W
Last Name:WOODARD
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:W
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CPNP
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3516
Mailing Address - Fax:757-686-0230
Practice Address - Street 1:3060 GODWIN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8274
Practice Address - Country:US
Practice Address - Phone:757-923-9660
Practice Address - Fax:757-923-9665
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024103364363L00000X
VA17000970363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007780281Medicaid
VA335590NOtherOPTIMA
NC7003897Medicaid
NC7003897Medicaid