Provider Demographics
NPI:1275775215
Name:SMITH, PATRICIA JOAN (APRN CLINICAL SPECIA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JOAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN CLINICAL SPECIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 MILL HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2865
Mailing Address - Country:US
Mailing Address - Phone:203-953-3374
Mailing Address - Fax:203-336-4395
Practice Address - Street 1:399 MILL HILL AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2865
Practice Address - Country:US
Practice Address - Phone:203-953-3374
Practice Address - Fax:203-336-4395
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000750364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health