Provider Demographics
NPI:1124854609
Name:SMIDT, BRETTANIE NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:BRETTANIE
Middle Name:NICOLE
Last Name:SMIDT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRETTANIE
Other - Middle Name:NICOLE
Other - Last Name:BLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10175 CREST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-2616
Mailing Address - Country:US
Mailing Address - Phone:928-399-9916
Mailing Address - Fax:
Practice Address - Street 1:1400 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2643
Practice Address - Country:US
Practice Address - Phone:850-444-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11035360363LF0000X
FLRN9477609163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily