Provider Demographics
NPI:1881837144
Name:WOOD, AUTUMN L, (PA)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:L,
Last Name:WOOD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:L
Other - Last Name:ASBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4611 NW 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-4898
Mailing Address - Country:US
Mailing Address - Phone:352-371-0301
Mailing Address - Fax:352-371-4635
Practice Address - Street 1:4611 NW 53RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4898
Practice Address - Country:US
Practice Address - Phone:352-371-0301
Practice Address - Fax:352-371-4635
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant