Provider Demographics
NPI:1851906994
Name:DIVINCENZO-SMITH, JANINE MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:MARIE
Last Name:DIVINCENZO-SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10746 W BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33898-8334
Mailing Address - Country:US
Mailing Address - Phone:863-224-5173
Mailing Address - Fax:
Practice Address - Street 1:1603 S HIAWASSEE RD STE 130
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6439
Practice Address - Country:US
Practice Address - Phone:863-224-5173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily