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NPI Code Detail

MEDICARE: LETITIA LYNNETTE SMILEY B.A.

MEDICARE: LETITIA LYNNETTE SMILEY B.A.
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1881709954
Entity Type Code : Individual
Provider Name (Legal Business Name) : LETITIA LYNNETTE SMILEY B.A.
Provider Business Mailing Address
First Line : 3725 BELFORT RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-5813
Country : US
Telephone Number : 904-296-1055
Fax Number : 904-448-1820
Provider Business Practice Location Address
First Line : 3725 BELFORT RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-5813
Country : US
Telephone Number : 904-296-1055
Fax Number : 904-448-1820
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2006
Last Update Date : 07/09/2007

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