Provider Demographics
NPI:1164759957
Name:SMITH, SONDRA (ARNP)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W MOWRY DR
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-5746
Mailing Address - Country:US
Mailing Address - Phone:305-248-4334
Mailing Address - Fax:305-245-1161
Practice Address - Street 1:810 W MOWRY DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-5746
Practice Address - Country:US
Practice Address - Phone:305-248-4334
Practice Address - Fax:305-245-1161
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9203820363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001642600Medicaid
FL001642600Medicaid