Provider Demographics
NPI:1659748879
Name:SMITH, RHONDA L (BC-HIS)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6218 US HIGHWAY 301 N
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-3065
Mailing Address - Country:US
Mailing Address - Phone:941-722-7200
Mailing Address - Fax:
Practice Address - Street 1:6218 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-3065
Practice Address - Country:US
Practice Address - Phone:941-722-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4818174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist