Provider Demographics
NPI:1508510181
Name:SMITH, VENESSA STACY ANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:VENESSA
Middle Name:STACY ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:VENESSA
Other - Middle Name:STACY ANN
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:960 E 221ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1016
Mailing Address - Country:US
Mailing Address - Phone:718-414-4225
Mailing Address - Fax:
Practice Address - Street 1:960 E 221ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-1016
Practice Address - Country:US
Practice Address - Phone:718-414-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY695400163W00000X
NY349982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse