Provider Demographics
NPI:1588958326
Name:SMITH, CAROLINE ELIZABETH (DPM)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-4134
Mailing Address - Country:US
Mailing Address - Phone:407-687-3577
Mailing Address - Fax:
Practice Address - Street 1:450 W CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2436
Practice Address - Country:US
Practice Address - Phone:321-397-2699
Practice Address - Fax:407-926-0500
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR173213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6505UOtherBCBS
FL6505UOtherBCBS