MEDICARE: BRETTANIE NICOLE SMIDT FNP-C

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	363LF0000X	Family Nurse Practitioner	APRN11035360	FL
2	163W00000X	Registered Nurse	RN9477609	FL

General Provider Information

NPI Number	:	1124854609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETTANIE NICOLE SMIDT FNP-C

Provider Business Mailing Address
First Line	:	10175 CREST RIDGE DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32514-2616
Country	:	US
Telephone Number	:	928-399-9916
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 N PALAFOX ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32501-2643
Country	:	US
Telephone Number	:	850-444-9449
Fax Number	:

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

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	09/16/2024

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