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General NPI Number Information
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NPI Number | 1972786903
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Entity Type | Individual
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Provider Name | CAROLINE O SMITH PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 1670 ST VINCENTS WAY
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City | MIDDLEBURG
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State | FL
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Zip | 32068-8447
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Country | US
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Telephone | 904-602-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 96 E TEAGUE BAY DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3093
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Country | US
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Telephone | 203-572-2439
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 002022
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9106283
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License Number State | FL
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