Healthcare Provider Details

I. General information

NPI: 1780141325
Provider Name (Legal Business Name): JACINDA LYNN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 FOREST HILL BLVD
WEST PALM BEACH FL
33406-5931
US

IV. Provider business mailing address

2105 BEAUTIFUL AVE
WEST PALM BEACH FL
33407-6316
US

V. Phone/Fax

Practice location:
  • Phone: 561-616-8411
  • Fax:
Mailing address:
  • Phone: 561-248-4819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: