MEDICARE: MELISSA GARRISON SMITH APRN

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4704194300	MI
2	363LF0000X	Family Nurse Practitioner	9270004	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	JQ238	OTHER	FL	MEDICARE
5	AZ946Z	OTHER	FL	MEDICARE PTAN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	700G560080	OTHER	MI	BCBS GROUP-THREE RIVERS HEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	Y0JU7	OTHER	FL	BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1053393066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA GARRISON SMITH APRN

Provider Business Mailing Address
First Line	:	38135 MARKET SQ
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-7505
Country	:	US
Telephone Number	:	352-567-0188
Fax Number	:	813-355-5101

Provider Business Practice Location Address
First Line	:	7229 US HIGHWAY 301 S
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-4346
Country	:	US
Telephone Number	:	813-677-8418
Fax Number	:	813-355-5906

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/29/2023

7239 US HIGHWAY 301 S
RIVERVIEW, FL
33578-4346

Practice Phone: 813-741-2100
Practice Fax: 813-741-2003