Provider Demographics
NPI:1497775340
Name:SMART, DONALD E (CRNA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:SMART
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 VISCAYA AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-2033
Mailing Address - Country:US
Mailing Address - Phone:407-908-3139
Mailing Address - Fax:407-888-9166
Practice Address - Street 1:608 VISCAYA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-2033
Practice Address - Country:US
Practice Address - Phone:407-908-3139
Practice Address - Fax:407-888-9166
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9176419367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3056066 00Medicaid
FL3056066 00Medicaid