Provider Demographics
NPI:1083881254
Name:SMART, ANGELA GRACE (ARNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:GRACE
Last Name:SMART
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-4924
Mailing Address - Country:US
Mailing Address - Phone:727-869-7755
Mailing Address - Fax:727-869-7372
Practice Address - Street 1:8501 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-4924
Practice Address - Country:US
Practice Address - Phone:727-869-7755
Practice Address - Fax:727-869-7372
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9197937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004624800Medicaid
FL004624800Medicaid