Provider Demographics
NPI:1043548290
Name:SMITH, MICHAEL AUSTIN (ARNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:AUSTIN
Last Name:SMITH
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1405 CENTERVILLE RD
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4655
Mailing Address - Country:US
Mailing Address - Phone:850-877-7886
Mailing Address - Fax:850-877-0738
Practice Address - Street 1:1405 CENTERVILLE RD
Practice Address - Street 2:SUITE 5000
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4655
Practice Address - Country:US
Practice Address - Phone:850-877-7886
Practice Address - Fax:850-877-0738
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9264894363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner