Healthcare Provider Details

I. General information

NPI: 1356202071
Provider Name (Legal Business Name): SSMITH, APRN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11470 WESTON COURSE LOOP
RIVERVIEW FL
33579-3956
US

IV. Provider business mailing address

11470 WESTON COURSE LOOP
RIVERVIEW FL
33579-3956
US

V. Phone/Fax

Practice location:
  • Phone: 727-265-0706
  • Fax:
Mailing address:
  • Phone: 727-265-0706
  • Fax: 321-616-8129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SMITH
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 727-265-0706