Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | APRN11004537 | FL |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | APRN11004537 | FL |
NPI | 1336782143 |
---|---|
Provider Name | Christina Lynn Smith |
First Address | Port St Lucie, FL 34986-2737 |
Second Address | Coral Gables, FL 33146-2423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2019 |
Last Update Date | 28/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APRN11004537 | MEDICAL LICENSE (01) | FL |