Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | APRN2502602 | FL |
NPI | 1174875660 |
---|---|
Provider Name | Lisa Lynn Smith |
First Address | Orlando, FL 32819-8001 |
Second Address | Orlando, FL 32803-1248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2012 |
Last Update Date | 09/11/2021 |