Provider Demographics
NPI:1124241831
Name:SMITH, TINA CARITA (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:CARITA
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-0230
Mailing Address - Country:US
Mailing Address - Phone:706-894-2714
Mailing Address - Fax:706-894-2715
Practice Address - Street 1:184 PROFESSIONAL DR UNIT A
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:GA
Practice Address - Zip Code:30511-4012
Practice Address - Country:US
Practice Address - Phone:706-894-2714
Practice Address - Fax:706-894-2715
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN063641163WG0000X, 363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health