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General NPI Number Information
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NPI Number | 1699318295
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Entity Type | Individual
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Provider Name | SERGEY SMIRNOV NP
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Gender | Male
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Dates
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Enumeration Date | 10/26/2019
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 255 RIVERTOWN SHOPS DR STE 102-161
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City | ST JOHNS
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State | FL
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Zip | 32259-7506
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Country | US
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Telephone | 904-377-3154
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Fax |
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Provider Business Mailing Address
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Address Line | 6629 BROADWAY APT 5C
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City | BRONX
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State | NY
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Zip | 10471-2040
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Country | US
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Telephone | 646-552-6494
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 345197
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11005649
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License Number State | FL
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