Healthcare Provider Details

I. General information

NPI: 1437794948
Provider Name (Legal Business Name): GINA SMITH APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 HURFFVILLE CROSS KEYS RD
TURNERSVILLE NJ
08012-2453
US

IV. Provider business mailing address

151 FRIES MILL RD STE 301
TURNERSVILLE NJ
08012-2016
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-2500
  • Fax:
Mailing address:
  • Phone: 856-513-4124
  • Fax: 856-302-5932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00980100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: