Provider Demographics
NPI:1356538623
Name:WOODS, EDWINA JO (LPN)
Entity type:Individual
Prefix:MRS
First Name:EDWINA
Middle Name:JO
Last Name:WOODS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:EDWINA
Other - Middle Name:JO
Other - Last Name:COLVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:936 SE BYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-4061
Mailing Address - Country:US
Mailing Address - Phone:772-879-3117
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:800-879-4471
Practice Address - Fax:610-834-7525
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5148605164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse