Provider Demographics
NPI:1629362199
Name:WOODRUFF, MILDRED SUE (APRN, BSN, MSN, FNP)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:SUE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:APRN, BSN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-3975
Mailing Address - Country:US
Mailing Address - Phone:772-461-1402
Mailing Address - Fax:561-847-2306
Practice Address - Street 1:1505 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-3975
Practice Address - Country:US
Practice Address - Phone:772-461-1402
Practice Address - Fax:561-847-2306
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28196047A163W00000X
KY3006942363LW0102X
FLARNP9244530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3006942Medicare UPIN
KY3006942Medicaid
KY3006942Medicare PIN
KY3006942Medicare Oscar/Certification