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General NPI Number Information
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NPI Number | 1750113783
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Entity Type | Individual
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Provider Name | TYLER JUSTIN SMITH DNP, FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1801 SE HILLMOOR DR STE C-207
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7574
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Country | US
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Telephone | 772-335-4234
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Fax | 772-335-4236
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Provider Business Mailing Address
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Address Line | 1801 SE HILLMOOR DR STE C-207
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7574
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Country | US
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Telephone | 772-335-4234
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Fax | 772-335-4236
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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 | APRN11035424
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License Number State | FL
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