Provider Demographics
NPI:1275597320
Name:SMITH-MCKINNEY, HARRIETT WILLIEMAE (PA-C)
Entity Type:Individual
Prefix:
First Name:HARRIETT
Middle Name:WILLIEMAE
Last Name:SMITH-MCKINNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HARRIETT
Other - Middle Name:SMITH
Other - Last Name:BYNOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2500 CITRUS BLVD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3063
Mailing Address - Country:US
Mailing Address - Phone:352-347-5225
Mailing Address - Fax:352-347-1073
Practice Address - Street 1:10762 SE US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3805
Practice Address - Country:US
Practice Address - Phone:352-347-5225
Practice Address - Fax:352-347-1073
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2621363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP52440Medicare UPIN
FLE7016AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER