Provider Demographics
NPI:1992296719
Name:SMITH SAINTIL, MAKELOGE
Entity type:Individual
Prefix:
First Name:MAKELOGE
Middle Name:
Last Name:SMITH SAINTIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 SW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2731
Mailing Address - Country:US
Mailing Address - Phone:844-665-4827
Mailing Address - Fax:877-902-3831
Practice Address - Street 1:180 SW 84TH AVE STE B
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2731
Practice Address - Country:US
Practice Address - Phone:844-665-4827
Practice Address - Fax:877-902-3831
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9360321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily