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General NPI Number Information
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NPI Number | 1659632735
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Entity Type | Individual
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Provider Name | MISS JACQUELINE SMITH
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Gender | Female
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 15843 SW 14TH CT
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-2363
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Country | US
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Telephone | 954-608-2859
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Fax | 754-816-5928
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Provider Business Mailing Address
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Address Line | 15843 SW 14CT
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City | PEMBROKE PINES
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State | FL
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Zip | 33027
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Country | US
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Telephone | 954-608-2859
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Fax | 754-816-5928
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 232682
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License Number State | FL
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