Healthcare Provider Details

I. General information

NPI: 1538129218
Provider Name (Legal Business Name): NINA AGNES SMITH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E DUVAL ST
JACKSONVILLE FL
32202-3201
US

IV. Provider business mailing address

41 E DUVAL ST
JACKSONVILLE FL
32202-3201
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-2766
  • Fax: 904-549-8300
Mailing address:
  • Phone: 904-399-2766
  • Fax: 904-549-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2192122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: