Provider Demographics
NPI:1245531771
Name:SMITH, HOLLIE SUZANNE (APRN)
Entity type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:SUZANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1597
Mailing Address - Country:US
Mailing Address - Phone:866-881-0979
Mailing Address - Fax:203-643-2000
Practice Address - Street 1:30 HYDE AVE STE 109
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4503
Practice Address - Country:US
Practice Address - Phone:860-454-0303
Practice Address - Fax:860-875-4242
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004550363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner