Provider Demographics
NPI:1720366982
Name:WOODFORD, JENNIFER THERESA (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:THERESA
Last Name:WOODFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:THERESA
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2220 VESTAL PKWY E FL 2
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1947
Mailing Address - Country:US
Mailing Address - Phone:607-306-7546
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:2220 VESTAL PKWY E FL 2
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1947
Practice Address - Country:US
Practice Address - Phone:607-306-7546
Practice Address - Fax:607-821-7848
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY594132163W00000X
NYF336916-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03447481Medicaid
NY03447481Medicaid