Provider Demographics
NPI:1467865717
Name:SMITH, CORA L (RN)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13150 NE COUNTY ROAD 339
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-8852
Mailing Address - Country:US
Mailing Address - Phone:352-493-1962
Mailing Address - Fax:
Practice Address - Street 1:13150 NE COUNTY ROAD 339
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-8852
Practice Address - Country:US
Practice Address - Phone:352-493-1962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000187014163WM0705X
FLRN9334664163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical