Provider Demographics
NPI:1750916797
Name:SMITH, SEBASTIAN FREEMAN (NP)
Entity type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:FREEMAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 N CENTRAL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2463
Mailing Address - Country:US
Mailing Address - Phone:480-999-4954
Mailing Address - Fax:480-999-4712
Practice Address - Street 1:9200 N CENTRAL AVE STE 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2463
Practice Address - Country:US
Practice Address - Phone:480-999-4954
Practice Address - Fax:480-999-4712
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ239177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ004532Medicaid