MEDICARE: CHIKITA DOMONIQUE SMITH APRN

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	APRN11046549	FL

General Provider Information

NPI Number	:	1124960554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIKITA DOMONIQUE SMITH APRN

Provider Business Mailing Address
First Line	:	12668 SHEFFIELD WALK LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-4989
Country	:	US
Telephone Number	:	904-855-7779
Fax Number	:

Provider Business Practice Location Address
First Line	:	12668 SHEFFIELD WALK LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-4989
Country	:	US
Telephone Number	:	904-855-7779
Fax Number	:

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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