Healthcare Provider Details

I. General information

NPI: 1649143611
Provider Name (Legal Business Name): STEPHANIE ANNE SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 N COURTENAY PKWY STE L
MERRITT ISLAND FL
32953-4463
US

IV. Provider business mailing address

PO BOX 320041
COCOA BEACH FL
32932-0041
US

V. Phone/Fax

Practice location:
  • Phone: 321-978-5122
  • Fax: 321-507-4317
Mailing address:
  • Phone: 727-265-0706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11042575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: