Healthcare Provider Details

I. General information

NPI: 1679179543
Provider Name (Legal Business Name): LAYLA RENEE LUNDQUIST-SMITH MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 CREIGHTON RD
PENSACOLA FL
32504-7218
US

IV. Provider business mailing address

2114 CREIGHTON RD
PENSACOLA FL
32504-7218
US

V. Phone/Fax

Practice location:
  • Phone: 850-848-9500
  • Fax: 850-901-0009
Mailing address:
  • Phone: 850-848-9500
  • Fax: 850-901-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAYLA LUNDQUIST-SMITH
Title or Position: SOLE OWNER
Credential: MD
Phone: 850-529-4960