Provider Demographics
NPI:1376074682
Name:SMITH, ADAM ONEIL (APRN)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:ONEIL
Last Name:SMITH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9422 ARLINGTON EXPY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-8231
Mailing Address - Country:US
Mailing Address - Phone:904-559-1844
Mailing Address - Fax:904-900-7707
Practice Address - Street 1:9422 ARLINGTON EXPY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-8231
Practice Address - Country:US
Practice Address - Phone:904-559-1844
Practice Address - Fax:904-900-7707
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN296323363LF0000X
FLAPRN9397007363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020589900Medicaid