MEDICARE: DANIELLA SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	11021183	FL
2	363LF0000X	Family Nurse Practitioner	APRN11021183	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124744289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLA SMITH

Provider Business Mailing Address
First Line	:	405 S ARRAWANA AVE UNIT 6
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4135
Country	:	US
Telephone Number	:	813-751-6720
Fax Number	:

Provider Business Practice Location Address
First Line	:	4503 N 22ND ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-6201
Country	:	US
Telephone Number	:	813-738-6684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	12/15/2022

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Directions to “ DANIELLA SMITH ” Practice Location

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