Provider Demographics
NPI:1518123173
Name:SMITH, ELIZABETH DARLENE (FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DARLENE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 NORTHBROOKE PLAZA DR STE 106
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8100
Mailing Address - Country:US
Mailing Address - Phone:239-350-4900
Mailing Address - Fax:833-902-3605
Practice Address - Street 1:2590 NORTHBROOKE PLAZA DR STE 106
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8100
Practice Address - Country:US
Practice Address - Phone:239-350-4900
Practice Address - Fax:833-902-3605
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN307089363LF0000X
FL9321441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2884811Medicaid
FL1518123173OtherNPI
FLFH618YMedicare UPIN