Healthcare Provider Details

I. General information

NPI: 1457224776
Provider Name (Legal Business Name): AMBER SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S COLLEGE AVE STE 115
NEWARK DE
19713-1324
US

IV. Provider business mailing address

25 FLINTHILL DR
NEWARK DE
19702-2838
US

V. Phone/Fax

Practice location:
  • Phone: 302-273-0727
  • Fax: 302-273-0845
Mailing address:
  • Phone: 347-498-5028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberACOO8452
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0051361
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0013312
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0013312
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberACOO8452
License Number StateMD
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP005683
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: