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General NPI Number Information
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NPI Number | 1851906994
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Entity Type | Individual
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Provider Name | JANINE MARIE DIVINCENZO-SMITH FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 1603 S HIAWASSEE RD STE 130
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City | ORLANDO
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State | FL
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Zip | 32835-6439
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Country | US
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Telephone | 863-224-5173
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Fax |
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Provider Business Mailing Address
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Address Line | 10746 W BEACH PKWY
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City | LAKE WALES
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State | FL
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Zip | 33898-8334
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Country | US
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Telephone | 863-224-5173
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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 | 11009122
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License Number State | FL
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