Provider Demographics
NPI:1205349594
Name:SMITH, TODD JOSEPH (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:JOSEPH
Last Name:SMITH
Suffix:
Gender:M
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 UPPER MEEHAN RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-5284
Mailing Address - Country:US
Mailing Address - Phone:802-453-6113
Mailing Address - Fax:
Practice Address - Street 1:61 COURT DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:VT
Practice Address - Zip Code:05733-8407
Practice Address - Country:US
Practice Address - Phone:802-247-3755
Practice Address - Fax:802-247-4560
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0132665363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health