Provider Demographics
NPI:1073735767
Name:SMITH, PAULA FITZGERALD (FNP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:FITZGERALD
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 E. RIGGS RD.
Mailing Address - Street 2:#1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249
Mailing Address - Country:US
Mailing Address - Phone:480-786-4441
Mailing Address - Fax:480-786-4609
Practice Address - Street 1:3960 E RIGGS RD
Practice Address - Street 2:#1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5411
Practice Address - Country:US
Practice Address - Phone:480-786-4441
Practice Address - Fax:480-786-4609
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN104237363LF0000X
AZAP0814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ530148Medicaid
AZMS0136499OtherDEA