Provider Demographics
NPI:1336245067
Name:SMITH, LAWRENCE J (APRN-C, DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:APRN-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32815 US HIGHWAY 19 N STE 200
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3145
Mailing Address - Country:US
Mailing Address - Phone:702-285-1190
Mailing Address - Fax:
Practice Address - Street 1:32815 US HIGHWAY 19 N STE 200
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3145
Practice Address - Country:US
Practice Address - Phone:702-285-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00852111N00000X
NVAPRN002152363L00000X
FLAPRN11022437363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No111N00000XChiropractic ProvidersChiropractor
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU80105Medicare UPIN
NVV37830Medicare ID - Type Unspecified