Healthcare Provider Details

I. General information

NPI: 1669761003
Provider Name (Legal Business Name): AMY JOY FISHMAN-SMITH RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY JOY SMITH RN, NP

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 E CHAPMAN AVE
ORANGE CA
92866-2221
US

IV. Provider business mailing address

3419 E CHAPMAN AVE # 404
ORANGE CA
92869-3812
US

V. Phone/Fax

Practice location:
  • Phone: 714-782-0042
  • Fax: 650-241-1129
Mailing address:
  • Phone: 714-782-0042
  • Fax: 650-241-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number393692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: