Healthcare Provider Details

I. General information

NPI: 1861325359
Provider Name (Legal Business Name): JENNA APRIL SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 BAPTIST WAY
PENSACOLA FL
32503-2254
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 954-471-0133
  • Fax:
Mailing address:
  • Phone: 954-471-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number9554009
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: