Healthcare Provider Details

I. General information

NPI: 1760763833
Provider Name (Legal Business Name): CATHY LYNN SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N US HIGHWAY 1
FORT PIERCE FL
34950-9125
US

IV. Provider business mailing address

827 18TH ST
VERO BEACH FL
32960-6481
US

V. Phone/Fax

Practice location:
  • Phone: 772-468-9900
  • Fax: 772-468-2364
Mailing address:
  • Phone: 772-925-8200
  • Fax: 772-925-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP704992
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP704992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: