Provider Demographics
NPI:1982055653
Name:SMITH, ANTWENETTE CHARAE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANTWENETTE
Middle Name:CHARAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MELODY DR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-3644
Mailing Address - Country:US
Mailing Address - Phone:912-272-1617
Mailing Address - Fax:
Practice Address - Street 1:106 E BROAD ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-2917
Practice Address - Country:US
Practice Address - Phone:912-454-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily