Healthcare Provider Details

I. General information

NPI: 1669921771
Provider Name (Legal Business Name): ANGELA L SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3958 BROWN PARK DR STE D
HILLIARD OH
43026-1160
US

IV. Provider business mailing address

3958 BROWN PARK DR STE D
HILLIARD OH
43026-1160
US

V. Phone/Fax

Practice location:
  • Phone: 919-932-5700
  • Fax: 919-933-6881
Mailing address:
  • Phone: 919-932-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019959
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: