Provider Demographics
NPI:1033582044
Name:SMITH, BRITTNI ANN (PA)
Entity Type:Individual
Prefix:
First Name:BRITTNI
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 BARTLETT AVE SUTE 101
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:956-717-5775
Mailing Address - Fax:956-717-5875
Practice Address - Street 1:7109 BARTLETT AVE SUTE 101
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-717-5775
Practice Address - Fax:956-717-5875
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1126309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant