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General NPI Number Information
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NPI Number | 1164900338
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Entity Type | Organization
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Legal Business Name | KATRINA JAHEN SMITH PLLC
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 21742 GARDEN WALK LOOP
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City | LAND O LAKES
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State | FL
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Zip | 34637-7610
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Country | US
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Telephone | 813-368-0683
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2101
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City | LAND O LAKES
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State | FL
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Zip | 34639-2101
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Country | US
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Telephone | 813-368-0683
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MRS. KATRINA JAHEN SMITH
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Credential | PA-C
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Telephone | 813-368-0683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9105946
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License Number State | FL
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