MEDICARE: AMANDA SMITH A.R.N.P.

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	ARNP9218887	FL

General Provider Information

NPI Number	:	1346648409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA SMITH A.R.N.P.

Provider Business Mailing Address
First Line	:	7647 W GULF TO LAKE HWY STE 6
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-7800
Country	:	US
Telephone Number	:	352-795-1718
Fax Number	:

Provider Business Practice Location Address
First Line	:	7647 W GULF TO LAKE HWY STE 6
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-7800
Country	:	US
Telephone Number	:	352-795-1718
Fax Number	:

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

Provider Enumeration Date	:	12/05/2014
Last Update Date	:	12/05/2014

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