Provider Demographics
NPI:1710170063
Name:SMITH, ANNE ELIZABETH (ARNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HOSPITAL DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2452
Mailing Address - Country:US
Mailing Address - Phone:386-437-4711
Mailing Address - Fax:386-437-4772
Practice Address - Street 1:21 HOSPITAL DR
Practice Address - Street 2:SUITE 280
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2452
Practice Address - Country:US
Practice Address - Phone:386-437-4711
Practice Address - Fax:386-437-4772
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9275183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily