Healthcare Provider Details

I. General information

NPI: 1770492738
Provider Name (Legal Business Name): OLIVIA MARIE SMOAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GARRETT AVE
LA PLATA MD
20646-5960
US

IV. Provider business mailing address

11335 COPPERLEAF LN
SAN DIEGO CA
92124-2803
US

V. Phone/Fax

Practice location:
  • Phone: 301-609-4000
  • Fax:
Mailing address:
  • Phone: 646-703-4006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR279331
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: