Healthcare Provider Details

I. General information

NPI: 1821052978
Provider Name (Legal Business Name): MARCIA EILEEN SMITH ARNP/CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 RALEIGH STREET
ORLANDO FL
32811-3926
US

IV. Provider business mailing address

6101 LAKE ELLENOR DRIVE
ORLANDO FL
32809-4616
US

V. Phone/Fax

Practice location:
  • Phone: 407-296-5177
  • Fax: 407-521-4699
Mailing address:
  • Phone: 407-858-1400
  • Fax: 407-858-5519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000630
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberARNP9246400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: