Provider Demographics
NPI:1386168433
Name:SMITH, MEMORY (NP)
Entity type:Individual
Prefix:
First Name:MEMORY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEMORY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEMORY HUTTO
Mailing Address - Street 1:5741 BEE RIDGE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5062
Mailing Address - Country:US
Mailing Address - Phone:941-951-2663
Mailing Address - Fax:941-552-3312
Practice Address - Street 1:5741 BEE RIDGE RD STE 400
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5062
Practice Address - Country:US
Practice Address - Phone:941-951-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902081363LF0000X
FL9466258363LF0000X
FLARNP9466258363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9466258OtherLICENSE