Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | ME85415 | FL |
NPI | 1073540092 |
---|---|
Provider Name | Michelle Marie Smith |
First Address | St Petersburg, FL 33701-4804 |
Second Address | St Petersburg, FL 33701-4634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 20/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
264416900 | (05) | FL |
H71866 | (02) | FL |