Healthcare Provider Details

I. General information

NPI: 1356973549
Provider Name (Legal Business Name): JUSTINE ANN SMITH MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 COMMERCE AVE STE 2
CARLISLE PA
17015-9128
US

IV. Provider business mailing address

1533 COMMERCE AVE STE 2
CARLISLE PA
17015-9128
US

V. Phone/Fax

Practice location:
  • Phone: 717-960-8956
  • Fax: 717-218-7557
Mailing address:
  • Phone: 717-960-8956
  • Fax: 717-218-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP027667
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number574776
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: