Healthcare Provider Details

I. General information

NPI: 1437408812
Provider Name (Legal Business Name): ELIZABETH C SMITH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 MASON AVE
DAYTONA BEACH FL
32117
US

IV. Provider business mailing address

1430 MASON AVE
DAYTONA BEACH FL
32117-4551
US

V. Phone/Fax

Practice location:
  • Phone: 386-257-2000
  • Fax: 386-274-2009
Mailing address:
  • Phone: 386-257-2000
  • Fax: 386-274-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1756042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: