Healthcare Provider Details

I. General information

NPI: 1609582097
Provider Name (Legal Business Name): CIJI S SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 E BASELINE RD STE 101
GILBERT AZ
85234-2427
US

IV. Provider business mailing address

19125 E MARY ANN WAY
QUEEN CREEK AZ
85142-9910
US

V. Phone/Fax

Practice location:
  • Phone: 480-776-0626
  • Fax: 480-776-0627
Mailing address:
  • Phone: 602-513-0699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRNP290692
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: