Provider Demographics
NPI:1124084033
Name:SMITH, PAULA KIM (CWHNP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:KIM
Last Name:SMITH
Suffix:
Gender:F
Credentials:CWHNP
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:KIM
Other - Last Name:DIEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 16568
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-6568
Mailing Address - Country:US
Mailing Address - Phone:904-472-2300
Mailing Address - Fax:904-472-2330
Practice Address - Street 1:3 SHIRCLIFF WAY
Practice Address - Street 2:STE 200 DILLON BLDG
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4757
Practice Address - Country:US
Practice Address - Phone:904-384-3699
Practice Address - Fax:904-384-8529
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN120829363LW0102X
FLARNP 9348308363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007251200Medicaid
FLGU422ZMedicare PIN