Provider Demographics
NPI:1134226269
Name:WOODBY, TINA MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:WOODBY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:NOLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1613 NORTH HARRISON PARKWAY
Mailing Address - Street 2:SUITE 200, MAILSTOP SH 9
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:954-616-3879
Practice Address - Street 1:801 E 6TH ST
Practice Address - Street 2:SUITE 205 GULF COAST REGIONAL MEDICAL CENTER
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-769-8341
Practice Address - Fax:954-851-1746
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3027672367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3005OtherBC/BS OF FL #
FLARNP3027672OtherFL CRNA LICENSE
FL304508100Medicaid
FLARNP3027672OtherFL CRNA LICENSE