Healthcare Provider Details

I. General information

NPI: 1255361101
Provider Name (Legal Business Name): LYNN M SMITH NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MEDICAL BLVD STE 103
SPRING HILL FL
34609-0221
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 352-340-2115
  • Fax: 352-340-2116
Mailing address:
  • Phone: 352-340-2115
  • Fax: 352-340-2116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9229817
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9229817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: