Provider Demographics
NPI:1720720683
Name:SMOOT, GINA K (MSN, FNP-C, CCM)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:K
Last Name:SMOOT
Suffix:
Gender:F
Credentials:MSN, FNP-C, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 HARBOUR PARK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2169
Mailing Address - Country:US
Mailing Address - Phone:804-893-0337
Mailing Address - Fax:689-202-0711
Practice Address - Street 1:5930 HARBOUR PARK DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2169
Practice Address - Country:US
Practice Address - Phone:804-893-0337
Practice Address - Fax:689-202-0711
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily