Provider Demographics
NPI:1710386388
Name:SMITH, MICHELE S (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 PARK PLACE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-4932
Mailing Address - Country:US
Mailing Address - Phone:727-608-8073
Mailing Address - Fax:727-333-6236
Practice Address - Street 1:300 PARK PLACE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4932
Practice Address - Country:US
Practice Address - Phone:727-608-8073
Practice Address - Fax:727-333-6236
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9342944363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily