Provider Demographics
NPI:1083641831
Name:SMRTKA, JENNIFER M (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:M
Last Name:SMRTKA
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:3848 FAU BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6437
Mailing Address - Country:US
Mailing Address - Phone:305-243-2279
Mailing Address - Fax:305-243-8108
Practice Address - Street 1:3848 FAU BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6437
Practice Address - Country:US
Practice Address - Phone:305-243-2279
Practice Address - Fax:305-243-8108
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF303724-1163WG0000X
FLARNP9289105163WG0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02759855Medicaid
NCQ17146Medicare UPIN
NY02759855Medicaid