Healthcare Provider Details

I. General information

NPI: 1386832111
Provider Name (Legal Business Name): GIGI YVETTE SMOAK L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 HILLCREST CIR NE
BRANFORD FL
32008-2948
US

IV. Provider business mailing address

108 HILLCREST CIR NE
BRANFORD FL
32008-2948
US

V. Phone/Fax

Practice location:
  • Phone: 386-935-4070
  • Fax:
Mailing address:
  • Phone: 386-935-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35784
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: