Provider Demographics
NPI:1063543643
Name:WHITE-SMITH, CAROLINE (PA)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:WHITE-SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 CHAMPIONS GATE BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8312
Mailing Address - Country:US
Mailing Address - Phone:407-479-2013
Mailing Address - Fax:
Practice Address - Street 1:3400 26TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-3537
Practice Address - Country:US
Practice Address - Phone:323-436-5019
Practice Address - Fax:323-337-9142
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant