Provider Demographics
NPI:1790937357
Name:SMITH, KRISTINA MARIE (APN-BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 MERCY BLVD
Mailing Address - Street 2:PLAZA D
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1753
Mailing Address - Country:US
Mailing Address - Phone:912-920-8898
Mailing Address - Fax:
Practice Address - Street 1:11700 MERCY BLVD
Practice Address - Street 2:PLAZA D
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1753
Practice Address - Country:US
Practice Address - Phone:912-920-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN160488 NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health