Provider Demographics
NPI:1437408812
Name:SMITH, ELIZABETH C (ARNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4551
Mailing Address - Country:US
Mailing Address - Phone:386-257-2000
Mailing Address - Fax:386-274-2009
Practice Address - Street 1:1430 MASON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-257-2000
Practice Address - Fax:386-274-2009
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1756042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily