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General NPI Number Information
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NPI Number | 1134505118
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Entity Type | Individual
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Provider Name | TARA D SMITH APRN,FNP-C, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/03/2015
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 1900 TEBEAU ST
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City | WAYCROSS
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State | GA
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Zip | 31501-6357
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Country | US
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Telephone | 912-338-6338
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Fax |
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Provider Business Mailing Address
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Address Line | 724 PINE NEEDLE RD
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City | DOUGLAS
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State | GA
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Zip | 31535-6512
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Country | US
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Telephone | 912-327-0263
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN213039
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN213039
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License Number State | GA
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