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General NPI Number Information
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NPI Number | 1487990503
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Entity Type | Individual
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Provider Name | LESLIE SMITH ARNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/18/2012
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 12675 BEACH BLVD #101
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City | JACKSONVILLE
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State | FL
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Zip | 32246
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Country | US
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Telephone | 904-204-1541
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 PALMER TER
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8939
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Country | US
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Telephone | 813-541-8911
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 9203170
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License Number State | FL
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