=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356202071
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SSMITH, APRN, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2025
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11470 WESTON COURSE LOOP
-----------------------------------------------------
City | RIVERVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33579-3956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-265-0706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11470 WESTON COURSE LOOP
-----------------------------------------------------
City | RIVERVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33579-3956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-265-0706
-----------------------------------------------------
Fax | 321-616-8129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STEPHANIE SMITH
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 727-265-0706
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------