Healthcare Provider Details

I. General information

NPI: 1821751579
Provider Name (Legal Business Name): MICHELLE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 ARBOUR POINT WAY APT 911
OCOEE FL
34761-5326
US

IV. Provider business mailing address

1170 ARBOUR POINT WAY APT 911
OCOEE FL
34761-5326
US

V. Phone/Fax

Practice location:
  • Phone: 407-595-7326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06210918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: