Healthcare Provider Details

I. General information

NPI: 1184142226
Provider Name (Legal Business Name): COURTNEY SMITH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 04/11/2024
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 BAILEY LN STE 200
NAPLES FL
34105-8523
US

IV. Provider business mailing address

3200 BAILEY LANE SUITE 200
NAPLES FL
34105-8523
US

V. Phone/Fax

Practice location:
  • Phone: 239-262-1721
  • Fax: 239-262-5903
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9110703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: