Healthcare Provider Details

I. General information

NPI: 1316785454
Provider Name (Legal Business Name): ANDREA SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 DOCTOR CIRCLE BUILDING C
WILMINGTON NC
28401
US

IV. Provider business mailing address

2605 RICOCHET LOOP APT 2108
WILMINGTON NC
28412-5413
US

V. Phone/Fax

Practice location:
  • Phone: 910-398-3941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5020456
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: