Healthcare Provider Details

I. General information

NPI: 1053977538
Provider Name (Legal Business Name): RENAY NATLIE SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8932 SW 97TH AVE
MIAMI FL
33176-1936
US

IV. Provider business mailing address

4272 SW 126TH AVE
MIRAMAR FL
33027-6037
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-5850
  • Fax:
Mailing address:
  • Phone: 954-662-6157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN9283771
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11002150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: