Provider Demographics
NPI:1508952292
Name:SMITH, TERRY LEE (FNP)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 HILLWAY CIR
Mailing Address - Street 2:STE 101
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-8754
Mailing Address - Country:US
Mailing Address - Phone:239-262-6550
Mailing Address - Fax:
Practice Address - Street 1:6605 HILLWAY CIR STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-8754
Practice Address - Country:US
Practice Address - Phone:239-262-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9360074363L00000X
NYF3318601363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02371906Medicaid
NY02371906Medicaid