Healthcare Provider Details

I. General information

NPI: 1871846535
Provider Name (Legal Business Name): NICOLE PACIFICO SMITH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

136 SUMMER CIR
BIRMINGHAM AL
35242-3541
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-3168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number1-113560
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: