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General NPI Number Information
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NPI Number | 1134258809
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Entity Type | Individual
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Provider Name | BRIAN JEFFREY SMITH A.T.,C
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 11000 UNIVERSITY PKWY
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City | PENSACOLA
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State | FL
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Zip | 32514-5732
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Country | US
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Telephone | 619-913-3087
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Fax |
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Provider Business Mailing Address
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Address Line | 8951 SALT GRASS DR
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City | PENSACOLA
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State | FL
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Zip | 32526-3264
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Country | US
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Telephone | 619-913-3087
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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