Healthcare Provider Details

I. General information

NPI: 1154847713
Provider Name (Legal Business Name): MARC C SMITH DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 68TH ST
HIALEAH FL
33016-1801
US

IV. Provider business mailing address

5220 NW 107TH PATH
DORAL FL
33178-3960
US

V. Phone/Fax

Practice location:
  • Phone: 561-623-2044
  • Fax:
Mailing address:
  • Phone: 305-333-2992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9309522
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP141646
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: