Healthcare Provider Details

I. General information

NPI: 1154001865
Provider Name (Legal Business Name): CARLIN MARCELLA SMART PIGFORD PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CARLIN MARCELLA SMART

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 LEE BLVD
LEHIGH ACRES FL
33971-1438
US

IV. Provider business mailing address

2913 LEE BLVD
LEHIGH ACRES FL
33971-1438
US

V. Phone/Fax

Practice location:
  • Phone: 239-491-8204
  • Fax: 239-491-6217
Mailing address:
  • Phone: 239-491-8204
  • Fax: 239-491-6217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11027489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: