Provider Demographics
NPI:1407418734
Name:SMITH, ANAKARIN MARELA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ANAKARIN
Middle Name:MARELA
Last Name:SMITH
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MILL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1506
Mailing Address - Country:US
Mailing Address - Phone:443-370-3939
Mailing Address - Fax:
Practice Address - Street 1:403 STADIUM DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-4247
Practice Address - Country:US
Practice Address - Phone:850-644-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer