Provider Demographics
NPI:1710609458
Name:VISWANATH, SMITHA (APRN)
Entity Type:Individual
Prefix:
First Name:SMITHA
Middle Name:
Last Name:VISWANATH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11722 SW 151ST PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2563
Mailing Address - Country:US
Mailing Address - Phone:786-973-9576
Mailing Address - Fax:
Practice Address - Street 1:11722SW,151PATH
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196
Practice Address - Country:US
Practice Address - Phone:786-973-9576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily