Provider Demographics
NPI:1912928748
Name:SMITH, NANCY J (ARNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 20TH AVE W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4246
Mailing Address - Country:US
Mailing Address - Phone:941-730-5880
Mailing Address - Fax:
Practice Address - Street 1:906 20TH AVE W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-4246
Practice Address - Country:US
Practice Address - Phone:941-730-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1378202363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3047768 00Medicaid
FLE7112Medicare ID - Type Unspecified
FL53831Medicare UPIN