Provider Demographics
NPI:1841765047
Name:SMITH, ANNA LOUISE (ARNP-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LOUISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 SPRINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-1317
Mailing Address - Country:US
Mailing Address - Phone:407-230-8560
Mailing Address - Fax:
Practice Address - Street 1:16461 DOMESTIC AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-6008
Practice Address - Country:US
Practice Address - Phone:877-266-7768
Practice Address - Fax:603-952-3900
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9368811363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1841765047Medicaid