MEDICARE: NOLA 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
1	163WG0000X	General Practice Registered Nurse	594909-1	NY
2	363LF0000X	Family Nurse Practitioner	344158	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043616485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOLA SMITH FNP

Provider Business Mailing Address
First Line	:	PO BOX 1251
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-7251
Country	:	US
Telephone Number	:	516-526-5416
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 HARBOR HOMES
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-7251
Country	:	US
Telephone Number	:	516-526-5416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2014
Last Update Date	:	11/29/2023

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