Provider Demographics
NPI:1952689390
Name:SMITH, ETHEL ELIZABETH (APRN)
Entity type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27810 SUMMERGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6919
Mailing Address - Country:US
Mailing Address - Phone:813-388-2948
Mailing Address - Fax:813-388-6827
Practice Address - Street 1:27810 SUMMERGATE BLVD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6919
Practice Address - Country:US
Practice Address - Phone:813-388-2948
Practice Address - Fax:813-388-6827
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023049363LF0000X, 363LP0808X
OHCOA.12467-NP363LF0000X
NVAPRN001807363LF0000X
AZAP5466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily