Provider Demographics
NPI:1104283464
Name:WOODS, KYLE BRYANT
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:BRYANT
Last Name:WOODS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 RED BUG LAKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9265
Mailing Address - Country:US
Mailing Address - Phone:407-366-6004
Mailing Address - Fax:
Practice Address - Street 1:8000 RED BUG LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9265
Practice Address - Country:US
Practice Address - Phone:407-366-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN212965363LF0000X
FLAPRN11029382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily