Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN11013627 | FL |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 1048303 | DC |
NPI | 1457830440 |
---|---|
Provider Name | Tracy Smith |
First Address | Gainesville, FL 32610 |
Second Address | Washington, DC 20010-3017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2018 |
Last Update Date | 09/07/2021 |