Provider Demographics
NPI:1841427796
Name:DYESS SMITH, ALLISON LENORE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:LENORE
Last Name:DYESS SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:ALLISON
Other - Middle Name:LENORE
Other - Last Name:DYESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:890 LANDRUM DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3073
Mailing Address - Country:US
Mailing Address - Phone:251-232-0558
Mailing Address - Fax:
Practice Address - Street 1:1900 DON WICKHAM DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1979
Practice Address - Country:US
Practice Address - Phone:352-394-4071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9259315163W00000X
FLARNP9259315367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001518700Medicaid
FLG900AOtherBLUE CROSS BLUE SHIELD FL
1841427796OtherTRICARE
FLCA611ZMedicare PIN