MEDICARE: MS. RACHEL LYNN 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	363L00000X	Nurse Practitioner	APRN11002486	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80805V	OTHER	FL	FL MEDICARE
2	OP576	OTHER	FL	HEALTH FIRST-MEDICARE

General Provider Information

NPI Number	:	1750474227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL LYNN SMITH APRN

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-500-5633
Fax Number	:	321-617-5633

Provider Business Practice Location Address
First Line	:	5717 21ST AVE WEST
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-5604
Country	:	US
Telephone Number	:	941-792-8383
Fax Number	:	941-792-8484

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	12/27/2022

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