| Natasha Woodham, Arnp | |
|
1621 Tennessee Ave Lynn Haven FL 32444-3652 | |
| (850) 872-0774 | |
| Not Available |
| Full Name | Natasha Woodham, Arnp |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1621 Tennessee Ave, Lynn Haven, Florida |
| Authorized Official Name and Position | Natasha Celest Woodham (OWNER/OPERATOR) |
| Authorized Official Contact | 8508720774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Natasha Woodham, Arnp 5819 Frank Hough Rd Panama City FL 32404-3062 Ph: (850) 896-1285 | Natasha Woodham, Arnp 1621 Tennessee Ave Lynn Haven FL 32444-3652 Ph: (850) 872-0774 |
| NPI Number | 1740665371 |
|---|---|
| Provider Enumeration Date | 07/24/2015 |
| Last Update Date | 03/12/2024 |
| Certification Date | 03/12/2024 |
| Medicare PECOS PAC ID | 4688989874 |
|---|---|
| Medicare Enrollment ID | O20150818003353 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740665371 | NPI | - | NPPES |
| 1073930947 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| 363LF0000X | Nurse Practitioner - Family | () | Primary |
| Provider Name | Natasha Celest Woodham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073930947 PECOS PAC ID: 3375763832 Enrollment ID: I20150818003407 |
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