Provider Demographics
NPI:1215485156
Name:SMITH, ERIC C (ARNP-C)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 W HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6106
Mailing Address - Country:US
Mailing Address - Phone:813-951-4954
Mailing Address - Fax:
Practice Address - Street 1:1840 MEASE DRIVE
Practice Address - Street 2:SUITE 319
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6605
Practice Address - Country:US
Practice Address - Phone:727-669-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9311301363LF0000X
NYF342098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019130100Medicaid
R9ZTCOtherBC BS