Provider Demographics
NPI:1942729496
Name:WOODFIN, HALLE
Entity Type:Individual
Prefix:
First Name:HALLE
Middle Name:
Last Name:WOODFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 LISA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORAN
Mailing Address - State:MO
Mailing Address - Zip Code:63771
Mailing Address - Country:US
Mailing Address - Phone:573-887-0272
Mailing Address - Fax:
Practice Address - Street 1:2173 CENTERVILLE PL # A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-385-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL409367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant