Provider Demographics
NPI:1386771830
Name:SMILEY, JACQUELINE MARIA (NP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MARIA
Last Name:SMILEY
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:TWO HURLEY PLAZA
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503
Mailing Address - Country:US
Mailing Address - Phone:810-262-6743
Mailing Address - Fax:810-235-1210
Practice Address - Street 1:2 HURLEY PLZ
Practice Address - Street 2:SUITE 204
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5903
Practice Address - Country:US
Practice Address - Phone:810-262-6743
Practice Address - Fax:810-235-1210
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704185382363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM32030116Medicare PIN