Provider Demographics
NPI:1568017945
Name:SMITH, ERICA ANNE (PA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 S CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-0504
Mailing Address - Country:US
Mailing Address - Phone:520-407-5600
Mailing Address - Fax:
Practice Address - Street 1:1260 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-0504
Practice Address - Country:US
Practice Address - Phone:520-407-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant