Healthcare Provider Details

I. General information

NPI: 1528977667
Provider Name (Legal Business Name): JONATHAN SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3277 FOX CHASE CIR N APT 210
PALM HARBOR FL
34683-2302
US

IV. Provider business mailing address

3277 FOX CHASE CIR N APT 210
PALM HARBOR FL
34683-2302
US

V. Phone/Fax

Practice location:
  • Phone: 813-510-8220
  • Fax:
Mailing address:
  • Phone: 813-510-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: