Provider Demographics
NPI:1124693767
Name:SMILJANIC, DARIJO (FNP)
Entity type:Individual
Prefix:
First Name:DARIJO
Middle Name:
Last Name:SMILJANIC
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-2512
Mailing Address - Country:US
Mailing Address - Phone:440-212-4805
Mailing Address - Fax:
Practice Address - Street 1:24500 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5601
Practice Address - Country:US
Practice Address - Phone:440-467-1954
Practice Address - Fax:440-895-5050
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily