Healthcare Provider Details

I. General information

NPI: 1003444787
Provider Name (Legal Business Name): KYNDAL SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYNDAL VANAERNAM

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

7439 MORNING DOVE TRL
FANNING SPRINGS FL
32693-7772
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0111
  • Fax:
Mailing address:
  • Phone: 352-578-4571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11019568
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11019568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: