Provider Demographics
NPI:1518215805
Name:SMITH, ERICA SELF (APRN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:SELF
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:HILLIARD
Other - Last Name:SELF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13820 OLD ST. AUGUSTINE RD #101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258
Mailing Address - Country:US
Mailing Address - Phone:904-260-2565
Mailing Address - Fax:904-246-6878
Practice Address - Street 1:13820 OLD ST. AUGUSTINE RD #101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258
Practice Address - Country:US
Practice Address - Phone:904-260-2565
Practice Address - Fax:904-246-6878
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9265570363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP1852302OtherMEDICAL LICENSE