Provider Demographics
NPI:1669740866
Name:SMITH, MARILYN RUTH (NP-C APRN)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:RUTH
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6273 EQUINE DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-4383
Mailing Address - Country:US
Mailing Address - Phone:561-271-0621
Mailing Address - Fax:850-331-3233
Practice Address - Street 1:6273 EQUINE DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-4383
Practice Address - Country:US
Practice Address - Phone:561-271-0621
Practice Address - Fax:850-331-3233
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9176708367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife