Provider Demographics
NPI:1396037073
Name:SMITH, PATRICIA J (FNP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 DE REIMER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2321
Mailing Address - Country:US
Mailing Address - Phone:917-330-1160
Mailing Address - Fax:347-341-5778
Practice Address - Street 1:4022 DE REIMER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2321
Practice Address - Country:US
Practice Address - Phone:917-330-1160
Practice Address - Fax:347-341-5778
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily