Provider Demographics
NPI:1518614668
Name:SMINK, LAURENTE EMMANUELLE
Entity Type:Individual
Prefix:
First Name:LAURENTE
Middle Name:EMMANUELLE
Last Name:SMINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 KEY LARGO POINTE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-2283
Mailing Address - Country:US
Mailing Address - Phone:717-440-4239
Mailing Address - Fax:
Practice Address - Street 1:2900 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4588
Practice Address - Country:US
Practice Address - Phone:770-619-6452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN266821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN266821OtherADVANCED PRACTICE