Provider Demographics
NPI:1386776425
Name:SMITH, GARRICK RUSSELL (CRNP-F)
Entity type:Individual
Prefix:MR
First Name:GARRICK
Middle Name:RUSSELL
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNP-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:410-682-2823
Mailing Address - Fax:410-682-9551
Practice Address - Street 1:6820 HOSPITAL DR
Practice Address - Street 2:SUITE 302
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4352
Practice Address - Country:US
Practice Address - Phone:410-682-2823
Practice Address - Fax:410-682-9551
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR091936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR091936OtherMD LICENSE