Provider Demographics
NPI:1881722379
Name:SMITH, NANCY K (CO)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 BRISTOL PT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5632
Mailing Address - Country:US
Mailing Address - Phone:407-740-7772
Mailing Address - Fax:
Practice Address - Street 1:1222 ORANGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4918
Practice Address - Country:US
Practice Address - Phone:407-740-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT76222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist