Healthcare Provider Details

I. General information

NPI: 1174875660
Provider Name (Legal Business Name): LISA LYNN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST CRITICAL CARE SPECIALISTS
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

9400 TURKEY LAKE RD
ORLANDO FL
32819-8001
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7283
  • Fax: 407-303-0347
Mailing address:
  • Phone: 407-842-8505
  • Fax: 407-370-2516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN2502602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: