Healthcare Provider Details

I. General information

NPI: 1518335538
Provider Name (Legal Business Name): SMILEY PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6867 SOUTHPOINT DR N
JACKSONVILLE FL
32216-8043
US

IV. Provider business mailing address

6867 SOUTHPOINT DR N
JACKSONVILLE FL
32216-8043
US

V. Phone/Fax

Practice location:
  • Phone: 904-619-6071
  • Fax: 904-212-0309
Mailing address:
  • Phone: 904-619-6071
  • Fax: 904-212-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME93753
License Number StateFL

VIII. Authorized Official

Name: MONICA B STEINMETZ
Title or Position: DIRECTOR
Credential:
Phone: 904-619-6071