Healthcare Provider Details

I. General information

NPI: 1366517385
Provider Name (Legal Business Name): CRISELLE SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISELLE FIGUEROA BEVERICK NP

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 WINDHAM PL S
SANDUSKY OH
44870-7245
US

IV. Provider business mailing address

3703 COLUMBUS AVE
SANDUSKY OH
44870-5707
US

V. Phone/Fax

Practice location:
  • Phone: 419-239-9502
  • Fax:
Mailing address:
  • Phone: 419-625-8085
  • Fax: 419-625-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3485
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number206081
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0039977
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: