Healthcare Provider Details

I. General information

NPI: 1801722988
Provider Name (Legal Business Name): CARLEY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8264 PRESTIGE COMMONS DR
TAMARAC FL
33321-1333
US

IV. Provider business mailing address

8264 PRESTIGE COMMONS DR
TAMARAC FL
33321-1333
US

V. Phone/Fax

Practice location:
  • Phone: 954-549-0375
  • Fax:
Mailing address:
  • Phone: 954-549-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: