MEDICARE: JENNY CRISTINA SMITH PA-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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1326416603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY CRISTINA SMITH PA-C

Provider Business Mailing Address
First Line	:	5071 HARVEST DR
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-6348
Country	:	US
Telephone Number	:	407-414-5073
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 E OSCEOLA PKWY
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-1611
Country	:	US
Telephone Number	:	407-452-3700
Fax Number	:

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

Provider Enumeration Date	:	09/03/2015
Last Update Date	:	04/09/2019

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