Provider Demographics
NPI:1386832111
Name:SMOAK, GIGI YVETTE (LMT)
Entity Type:Individual
Prefix:MS
First Name:GIGI
Middle Name:YVETTE
Last Name:SMOAK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HILLCREST CIR NE
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32008-2948
Mailing Address - Country:US
Mailing Address - Phone:386-935-4070
Mailing Address - Fax:
Practice Address - Street 1:108 HILLCREST CIR NE
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:FL
Practice Address - Zip Code:32008-2948
Practice Address - Country:US
Practice Address - Phone:386-935-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35784174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC-2065OtherBLUE CROSS BLUE SHIELD
FL12066OtherDEPARTMENT OF HEALTH
FL35784OtherDEPARTMENT OF HEALTH