Healthcare Provider Details

I. General information

NPI: 1295663813
Provider Name (Legal Business Name): DR. DERRICK L SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 NW 34TH BLVD
GAINESVILLE FL
32605-1150
US

IV. Provider business mailing address

4864 NW 75TH RD
GAINESVILLE FL
32653-1189
US

V. Phone/Fax

Practice location:
  • Phone: 352-538-5661
  • Fax:
Mailing address:
  • Phone: 352-538-5661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT4606
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: