Healthcare Provider Details

I. General information

NPI: 1376861096
Provider Name (Legal Business Name): KATHLEEN MARIE AUGUSTINE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN MARIE SMITH ARNP, CNM

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 LUCERNE TER
ORLANDO FL
32806-1017
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 407-316-8550
  • Fax: 407-316-8311
Mailing address:
  • Phone: 813-286-0033
  • Fax: 407-303-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN9185846
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN9185846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: