Provider Demographics
NPI:1417514035
Name:SMITH, JENNIFER L (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SE HILLMOOR DR STE B-105
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7545
Mailing Address - Country:US
Mailing Address - Phone:772-398-9911
Mailing Address - Fax:772-337-9955
Practice Address - Street 1:1801 SE HILLMOOR DR STE B-105
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7545
Practice Address - Country:US
Practice Address - Phone:772-398-9911
Practice Address - Fax:772-337-9955
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily