Healthcare Provider Details

I. General information

NPI: 1821164088
Provider Name (Legal Business Name): MRS. KRISTA LEIGH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 S KINGSWAY RD
SEFFNER FL
33584-6010
US

IV. Provider business mailing address

3102 S KINGSWAY RD
SEFFNER FL
33584-6010
US

V. Phone/Fax

Practice location:
  • Phone: 813-714-9137
  • Fax:
Mailing address:
  • Phone: 813-653-1149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number29786
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA7072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: