Provider Demographics
NPI:1649756719
Name:SMITH, GUILLENNE (MSN,APRN-FNP-C)
Entity Type:Individual
Prefix:
First Name:GUILLENNE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN,APRN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CLEMATIS ST STE 5-531
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5107
Mailing Address - Country:US
Mailing Address - Phone:561-671-4036
Mailing Address - Fax:
Practice Address - Street 1:245 SOUTH CONGRESS AVENUE
Practice Address - Street 2:FLORIDA DEPARTMENT OF HEALTH-DELRAY BEACH HEALTH CENTER
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445
Practice Address - Country:US
Practice Address - Phone:561-274-3100
Practice Address - Fax:561-266-6629
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9254635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL363L0000XMedicaid