=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548592876
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANN MARIE SMITH ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2010
-----------------------------------------------------
Last Update Date | 06/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10055 UNIVERSITY BLVD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32817-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-679-4800
-----------------------------------------------------
Fax | 407-679-0574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10055 UNIVERSITY BLVD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32817-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-679-4800
-----------------------------------------------------
Fax | 407-679-0574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 9218921
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------