Provider Demographics
NPI:1154001865
Name:SMART, CARLIN MARCELLA (PMHNP)
Entity type:Individual
Prefix:
First Name:CARLIN
Middle Name:MARCELLA
Last Name:SMART
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-2122
Mailing Address - Country:US
Mailing Address - Phone:239-791-9437
Mailing Address - Fax:
Practice Address - Street 1:1410 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-2122
Practice Address - Country:US
Practice Address - Phone:239-791-9437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027489363L00000X
FLAPRN11027489363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner