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NPI Code Detail

MEDICARE: TINA MARIE SMITH FNP

MEDICARE: TINA MARIE SMITH FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner21596TN

General Provider Information

NPI Number : 1023563368
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA MARIE SMITH FNP
Provider Business Mailing Address
First Line : PO BOX 850
Second Line :
City : ROGERSVILLE
State : TN
Zip : 37857-0850
Country : US
Telephone Number : 423-538-5116
Fax Number : 423-538-3861
Provider Business Practice Location Address
First Line : 229 HIGHWAY 19 E
Second Line :
City : BLUFF CITY
State : TN
Zip : 37618-1865
Country : US
Telephone Number : 423-538-5116
Fax Number : 423-538-3861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2016
Last Update Date : 08/10/2020

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