Healthcare Provider Details

I. General information

NPI: 1023520004
Provider Name (Legal Business Name): TANYA JENNETTE SMIT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 TORRANCE BLVD STE 720
TORRANCE CA
90503-4506
US

IV. Provider business mailing address

555 W UNIVERSITY DR STE 10
MESA AZ
85201-5633
US

V. Phone/Fax

Practice location:
  • Phone: 310-571-5957
  • Fax:
Mailing address:
  • Phone: 386-295-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95007705
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007705
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number254230
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number254230
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: