Provider Demographics
NPI:1528502481
Name:SMITH, CATHERINE (NP-C)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:TIBBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:727-777-4540
Mailing Address - Fax:727-248-0432
Practice Address - Street 1:7050 ULMERTON RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5003
Practice Address - Country:US
Practice Address - Phone:727-777-4540
Practice Address - Fax:727-248-0432
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9518336363L00000X
CORN. 1624847363LF0000X
FLAPRN11003087363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily