Healthcare Provider Details

I. General information

NPI: 1811343452
Provider Name (Legal Business Name): TASHA SMITH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5686 ESTABROOK WOODS DR APT 201
ORLANDO FL
32839-6117
US

IV. Provider business mailing address

5686 ESTABROOK WOODS DR APT 201
ORLANDO FL
32839-6117
US

V. Phone/Fax

Practice location:
  • Phone: 321-662-2346
  • Fax: 407-270-8068
Mailing address:
  • Phone: 321-662-2346
  • Fax: 407-270-8068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. TASHA LAVONNE SMITH
Title or Position: OWNER
Credential:
Phone: 407-270-8068