Provider Demographics
NPI:1992030696
Name:SMITH WALSH, DAWN (APRN, AGNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:SMITH WALSH
Suffix:
Gender:F
Credentials:APRN, AGNP, PMHNP-BC
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14910 N DALE MABRY HWY # 342203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1814
Mailing Address - Country:US
Mailing Address - Phone:813-838-1740
Mailing Address - Fax:
Practice Address - Street 1:14910 N. DALE MABRY HWY
Practice Address - Street 2:# 342203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618
Practice Address - Country:US
Practice Address - Phone:813-838-1740
Practice Address - Fax:813-575-9171
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006514363LG0600X, 363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113873900Medicaid