Provider Demographics
NPI:1215628045
Name:SMITH, JAYLA (FNP-C)
Entity type:Individual
Prefix:
First Name:JAYLA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:JAYLA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JAYLA SMITH FNP-C
Mailing Address - Street 1:980 64TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-5810
Mailing Address - Country:US
Mailing Address - Phone:727-798-9737
Mailing Address - Fax:
Practice Address - Street 1:980 64TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-5810
Practice Address - Country:US
Practice Address - Phone:727-798-9737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily