Healthcare Provider Details

I. General information

NPI: 1972033744
Provider Name (Legal Business Name): EDWARD LEWIS SMITH HIS, BSN, RN, CCRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S FORT HARRISON
CLEARWATER FL
33756
US

IV. Provider business mailing address

820 SOUTH FORT HARRISON AVE
CLEARWATER FL
33756
US

V. Phone/Fax

Practice location:
  • Phone: 727-581-7472
  • Fax:
Mailing address:
  • Phone: 727-581-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: