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General NPI Number Information
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NPI Number | 1063543643
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Entity Type | Individual
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Provider Name | CAROLINE WHITE-SMITH PA
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Gender | Female
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 3400 26TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33711-3537
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Country | US
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Telephone | 323-436-5019
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Fax | 323-337-9142
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Provider Business Mailing Address
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Address Line | 8390 CHAMPIONS GATE BLVD STE 215
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City | CHAMPIONS GATE
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State | FL
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Zip | 33896-8312
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Country | US
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Telephone | 407-479-2013
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9109516
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License Number State | FL
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