Provider Demographics
NPI:1740753920
Name:SMITH, PATRICK LYNN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5174 WOOD CIR E
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-9511
Mailing Address - Country:US
Mailing Address - Phone:863-370-7677
Mailing Address - Fax:
Practice Address - Street 1:5174 WOOD CIR E
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-9511
Practice Address - Country:US
Practice Address - Phone:863-370-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily