Provider Demographics
NPI:1134788383
Name:SMITH, SAMANTHA ETHALEE (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ETHALEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:113 SEABOARD LN STE 200B
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8282
Mailing Address - Country:US
Mailing Address - Phone:615-721-7024
Mailing Address - Fax:800-266-5158
Practice Address - Street 1:10739 DEERWOOD PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4839
Practice Address - Country:US
Practice Address - Phone:800-793-7050
Practice Address - Fax:866-509-6155
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily