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General NPI Number Information
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NPI Number | 1952543738
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Entity Type | Individual
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Provider Name | TINA MARIE SMITH P.A.
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Gender | Female
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 900 TRAILWOOD DR
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City | BOARDMAN
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State | OH
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Zip | 44512-5007
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Country | US
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Telephone | 330-726-2575
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Fax | 330-726-7789
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Provider Business Mailing Address
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Address Line | PO BOX 636988
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City | CINCINNATI
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State | OH
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Zip | 45263-6988
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Country | US
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Telephone | 888-940-2722
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Fax | 513-632-8898
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50002885
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License Number State | OH
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