Provider Demographics
NPI:1821052978
Name:SMITH, MARCIA EILEEN (ARNP/CNM)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:EILEEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 LAKE ELLENOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4616
Mailing Address - Country:US
Mailing Address - Phone:407-858-1400
Mailing Address - Fax:407-858-5519
Practice Address - Street 1:5151 RALEIGH STREET
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-3926
Practice Address - Country:US
Practice Address - Phone:407-296-5177
Practice Address - Fax:407-521-4699
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000630367A00000X
FLARNP9246400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307872800Medicaid
NY01742429Medicaid
FL307872800Medicaid