Provider Demographics
NPI:1275546582
Name:SMITH, RITA (ARNP)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:PRUETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:16355 NW WILLARD SMITH RD
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424
Mailing Address - Country:US
Mailing Address - Phone:850-674-1707
Mailing Address - Fax:
Practice Address - Street 1:19611 SR 20 W
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-3917
Practice Address - Country:US
Practice Address - Phone:850-674-5645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1756162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301663300Medicaid
FL301663300Medicaid