Healthcare Provider Details

I. General information

NPI: 1750474227
Provider Name (Legal Business Name): RACHEL LYNN SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL O'HANLON APRN

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5717 21ST AVE WEST
BRADENTON FL
34209-5604
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-8383
  • Fax: 941-792-8484
Mailing address:
  • Phone: 321-500-5633
  • Fax: 321-617-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11002486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: