Healthcare Provider Details

I. General information

NPI: 1164209177
Provider Name (Legal Business Name): JULIA SMITH CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 JOE DIMAGGIO DR
HOLLYWOOD FL
33021-5402
US

IV. Provider business mailing address

1010 SEMINOLE DR APT 511
FORT LAUDERDALE FL
33304-3218
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-5324
  • Fax:
Mailing address:
  • Phone: 518-937-7413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA845
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: