Provider Demographics
NPI:1689138273
Name:SMITH, ANDREW DYLAN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DYLAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15320 AMBERLY DR STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1647
Mailing Address - Country:US
Mailing Address - Phone:813-977-2090
Mailing Address - Fax:
Practice Address - Street 1:15320 AMBERLY DR STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1647
Practice Address - Country:US
Practice Address - Phone:813-977-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant