Healthcare Provider Details

I. General information

NPI: 1093652752
Provider Name (Legal Business Name): DIONNE K.O SMITH DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 GLADES RD
BOCA RATON FL
33431-6424
US

IV. Provider business mailing address

2531 SE KAYCEE CT
PORT ST LUCIE FL
34952-7136
US

V. Phone/Fax

Practice location:
  • Phone: 754-252-8223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11047170
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: