MEDICARE: MS. KAREN A SMITH RN

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	163W00000X	Registered Nurse	RN1044433649	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962117135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN A SMITH RN

Provider Business Mailing Address
First Line	:	13282 BLYTHEVILLE AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33981-4752
Country	:	US
Telephone Number	:	954-716-2215
Fax Number	:

Provider Business Practice Location Address
First Line	:	13282 BLYTHEVILLE AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33981-4752
Country	:	US
Telephone Number	:	954-716-2215
Fax Number	:

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

Provider Enumeration Date	:	01/20/2023
Last Update Date	:	01/20/2023

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