Provider Demographics
NPI:1700358538
Name:WOODSON, JACONDRIA PATREECE
Entity Type:Individual
Prefix:
First Name:JACONDRIA
Middle Name:PATREECE
Last Name:WOODSON
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 1:8764 DOVELAND DR APT D
Mailing Address - Street 2:
Mailing Address - City:PAHOKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33476-3222
Mailing Address - Country:US
Mailing Address - Phone:561-507-9178
Mailing Address - Fax:
Practice Address - Street 1:1639 FORUM PL STE 7
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2330
Practice Address - Country:US
Practice Address - Phone:561-712-8821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator