Healthcare Provider Details

I. General information

NPI: 1043872401
Provider Name (Legal Business Name): RACHAEL SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 SE OCEAN BLVD STE 300
STUART FL
34996-3341
US

IV. Provider business mailing address

938 SW MARTIN DOWNS BLVD
PALM CITY FL
34990-2816
US

V. Phone/Fax

Practice location:
  • Phone: 772-500-3680
  • Fax:
Mailing address:
  • Phone: 772-221-7620
  • Fax: 772-221-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11002978
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: