MEDICARE: MISS ASHLEY ANN SMITH 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	4704348986	MI

General Provider Information

NPI Number	:	1518700244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ASHLEY ANN SMITH FNP-C

Provider Business Mailing Address
First Line	:	438 W LAKE ST
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-8317
Country	:	US
Telephone Number	:	989-305-4073
Fax Number	:

Provider Business Practice Location Address
First Line	:	438 W LAKE ST
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-8317
Country	:	US
Telephone Number	:	989-305-4073
Fax Number	:

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

Provider Enumeration Date	:	06/19/2024
Last Update Date	:	02/03/2026

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