Healthcare Provider Details

I. General information

NPI: 1063942928
Provider Name (Legal Business Name): TIERRA NICOLE SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 SW 16TH ST DEPARTMENT OF EMERGENCY MEDICINE
GAINESVILLE FL
32610-0175
US

IV. Provider business mailing address

1329 SW 16TH ST DEPARTMENT OF EMERGENCY MEDICINE
GAINESVILLE FL
32610-0175
US

V. Phone/Fax

Practice location:
  • Phone: 352-733-1471
  • Fax:
Mailing address:
  • Phone: 352-733-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number98365
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME144267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: