Provider Demographics
NPI:1356339394
Name:SMITH, YOUN SUN C (ARNP)
Entity type:Individual
Prefix:
First Name:YOUN SUN
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0333
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:948 CYPRESS VILLAGE BLVD STE A
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6841
Practice Address - Country:US
Practice Address - Phone:813-633-3002
Practice Address - Fax:813-633-6392
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9183785363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ31048Medicare UPIN
FLU3854AMedicare ID - Type Unspecified