Provider Demographics
NPI:1639329105
Name:WOODS, HEATHER O (ARNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:O
Last Name:WOODS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-728-2500
Mailing Address - Fax:215-707-3639
Practice Address - Street 1:333 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2434
Practice Address - Country:US
Practice Address - Phone:215-728-2500
Practice Address - Fax:215-728-3639
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9269635363L00000X
TN20025363LF0000X
PASP017272363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000512800Medicaid
FLBF028YMedicare PIN
FL000512800Medicaid