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NPI Code Detail

MEDICARE: KRISTEN SMITH

MEDICARE: KRISTEN 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
1163W00000XRegistered Nurse9420886FL

General Provider Information

NPI Number : 1437751690
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN SMITH
Provider Business Mailing Address
First Line : 8773 MICMAC CT
Second Line :
City : POLK CITY
State : FL
Zip : 33868-6025
Country : US
Telephone Number : 734-652-9171
Fax Number :
Provider Business Practice Location Address
First Line : 7575 OSCEOLA POLK LINE RD
Second Line :
City : DAVENPORT
State : FL
Zip : 33896-9112
Country : US
Telephone Number : 321-677-0531
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2020
Last Update Date : 11/12/2020

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Directions to “ KRISTEN SMITH ” Practice Location

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