Provider Demographics
NPI:1962117135
Name:SMITH, KAREN A (RN)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13282 BLYTHEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-4752
Mailing Address - Country:US
Mailing Address - Phone:954-716-2215
Mailing Address - Fax:
Practice Address - Street 1:13282 BLYTHEVILLE AVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33981-4752
Practice Address - Country:US
Practice Address - Phone:954-716-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1044433649163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse