Provider Demographics
NPI:1639894520
Name:SMITH, PLATINUM CLIFTON
Entity Type:Individual
Prefix:
First Name:PLATINUM
Middle Name:CLIFTON
Last Name:SMITH
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 1:18347 S MCCONE CT
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-1023
Mailing Address - Country:US
Mailing Address - Phone:520-604-2633
Mailing Address - Fax:
Practice Address - Street 1:18347 S MCCONE CT
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-1023
Practice Address - Country:US
Practice Address - Phone:520-604-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ129095163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management