Provider Demographics
NPI:1235875311
Name:SMITH, ERIN THERESA
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:THERESA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:THERESA
Other - Last Name:MOGAVERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3909 SANTA FE ST E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7600
Mailing Address - Country:US
Mailing Address - Phone:407-453-2184
Mailing Address - Fax:
Practice Address - Street 1:2800 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3321
Practice Address - Country:US
Practice Address - Phone:904-256-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9594474163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse