MEDICARE: LAVANDA AYANA SMOOT MARTIN FNP-BC

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	163WG0000X	General Practice Registered Nurse	236919	SC
2	363LF0000X	Family Nurse Practitioner	29323	SC
3	247ZC0005X	Clinical Laboratory Director (Non-physician)

General Provider Information

NPI Number	:	1548936404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVANDA AYANA SMOOT MARTIN FNP-BC

Provider Business Mailing Address
First Line	:	2724 W PALMETTO ST STE 5
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29501-4909
Country	:	US
Telephone Number	:	843-799-2649
Fax Number	:	843-799-4224

Provider Business Practice Location Address
First Line	:	2724 W PALMETTO ST STE 5
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29501-4909
Country	:	US
Telephone Number	:	843-799-2649
Fax Number	:	843-799-4224

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

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	05/05/2026

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