Provider Demographics
NPI:1154625184
Name:SMYRNIOTIS, NIA MARINA (MD)
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:MARINA
Last Name:SMYRNIOTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5295 TOWN CENTER RD
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1080
Mailing Address - Country:US
Mailing Address - Phone:561-288-3520
Mailing Address - Fax:
Practice Address - Street 1:5295 TOWN CENTER RD
Practice Address - Street 2:SUITE # 201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1080
Practice Address - Country:US
Practice Address - Phone:561-288-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME691742083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice