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General NPI Number Information
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NPI Number | 1275274292
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Entity Type | Individual
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Provider Name | CJARDAE SMITH
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Gender | Female
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 1650 ART MUSEUM DR STE 11
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2188
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Country | US
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Telephone | 904-877-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 ART MUSEUM DR STE 11
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2188
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Country | US
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Telephone | 904-877-0800
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | CL1189139
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | CL1189139
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CL1189139
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License Number State | FL
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