Healthcare Provider Details

I. General information

NPI: 1891630992
Provider Name (Legal Business Name): AYANNA SMITH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 SW MAIN BLVD STE 101
LAKE CITY FL
32025
US

IV. Provider business mailing address

1206 SW MAIN BLVD STE 101
LAKE CITY FL
32025
US

V. Phone/Fax

Practice location:
  • Phone: 386-259-3424
  • Fax: 386-378-3426
Mailing address:
  • Phone: 386-259-3424
  • Fax: 386-378-3426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA78811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: