Healthcare Provider Details

I. General information

NPI: 1760421895
Provider Name (Legal Business Name): NELSON MICHAEL SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 N SEMORAN BLVD STE 204
WINTER PARK FL
32792-3800
US

IV. Provider business mailing address

1580 SANTA BARBARA BLVD
THE VILLAGES FL
32159-6827
US

V. Phone/Fax

Practice location:
  • Phone: 407-645-1847
  • Fax:
Mailing address:
  • Phone: 352-259-2159
  • Fax: 352-259-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME50488
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2018-00868
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME50488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: