Provider Demographics
NPI:1376503185
Name:SMITH, THOMAS J (CRNA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:3309 SW 34TH CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-3392
Mailing Address - Country:US
Mailing Address - Phone:352-237-0509
Mailing Address - Fax:352-237-9808
Practice Address - Street 1:1500 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6504
Practice Address - Country:US
Practice Address - Phone:352-237-0509
Practice Address - Fax:352-237-9808
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2034812367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000885574AMedicaid
FL3011186-00Medicaid
FL430059530Medicare PIN
FLG1105YMedicare PIN