Healthcare Provider Details

I. General information

NPI: 1720310956
Provider Name (Legal Business Name): ANNE HANCOCK SMITS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 BROAD AVE STE 330
GULFPORT MS
39501-2464
US

IV. Provider business mailing address

1391 BROAD AVE
GULFPORT MS
39501-2419
US

V. Phone/Fax

Practice location:
  • Phone: 228-575-1234
  • Fax: 228-865-3038
Mailing address:
  • Phone: 301-868-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0004154
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00276
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: