Healthcare Provider Details

I. General information

NPI: 1154756393
Provider Name (Legal Business Name): KATHLEEN R SMART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N COMMERCE PKWY STE 103
WESTON FL
33326-3255
US

IV. Provider business mailing address

1700 NW 49TH ST STE 125
FORT LAUDERDALE FL
33309-3750
US

V. Phone/Fax

Practice location:
  • Phone: 954-217-5700
  • Fax: 954-217-5704
Mailing address:
  • Phone: 954-217-5700
  • Fax: 954-217-5704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number9222846
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9222846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: