Provider Demographics
NPI:1013330299
Name:WOODRUFF, ANNA DANIELLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:DANIELLE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:DANIELLE
Other - Last Name:STREET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:499 GLOSTER CREEK VLG STE H3
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4661
Mailing Address - Country:US
Mailing Address - Phone:662-840-6026
Mailing Address - Fax:662-840-6030
Practice Address - Street 1:499 GLOSTER CREEK VLG STE H3
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4661
Practice Address - Country:US
Practice Address - Phone:662-840-6026
Practice Address - Fax:662-840-6030
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867633363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04106368Medicaid