Healthcare Provider Details

I. General information

NPI: 1942594833
Provider Name (Legal Business Name): DONNA CAROL SMITH MS, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEADE PKWY
SUFFOLK VA
23434-4259
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-686-3508
  • Fax: 757-686-0541
Mailing address:
  • Phone: 757-686-3516
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number363763
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170844
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: