Healthcare Provider Details

I. General information

NPI: 1144662594
Provider Name (Legal Business Name): MARIA A SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8740 CHEROKEE ST
YOUNGSTOWN FL
32466-2022
US

IV. Provider business mailing address

8740 CHEROKEE ST
YOUNGSTOWN FL
32466-2022
US

V. Phone/Fax

Practice location:
  • Phone: 850-814-9765
  • Fax:
Mailing address:
  • Phone: 850-814-9765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: