Healthcare Provider Details

I. General information

NPI: 1497115356
Provider Name (Legal Business Name): VICTORIA L SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JOHN ROEMMELT DR STE 101
HORSEHEADS NY
14845-8302
US

IV. Provider business mailing address

571 SAINT JOSEPHS BLVD FL 2
ELMIRA NY
14901-3230
US

V. Phone/Fax

Practice location:
  • Phone: 607-739-0352
  • Fax: 607-739-6909
Mailing address:
  • Phone: 607-271-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number340620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: