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General NPI Number Information
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NPI Number | 1376384818
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Entity Type | Individual
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Provider Name | HEATHER SMITH PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 1190 PELICAN BAY DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32119-1381
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Country | US
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Telephone | 386-206-8069
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Fax | 386-206-8069
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Provider Business Mailing Address
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Address Line | 1838 FOROUGH CIR
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City | PORT ORANGE
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State | FL
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Zip | 32128-6016
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Country | US
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Telephone | 860-305-8034
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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 | 0024194804
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.0040119
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11033249
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License Number State | FL
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