Provider Demographics
NPI:1023838851
Name:SMITH, ALICIA DANIELLE (RN)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:DANIELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7299 WILLOW WOOD RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32409-1589
Mailing Address - Country:US
Mailing Address - Phone:678-416-2892
Mailing Address - Fax:
Practice Address - Street 1:7299 WILLOW WOOD RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32409-1589
Practice Address - Country:US
Practice Address - Phone:678-416-2892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9650883163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse