Provider Demographics
NPI:1548526957
Name:SMITH, CHARLOTTE ANN (RN/BSN, MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN/BSN, MSN, FNP-BC
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:ANN
Other - Last Name:MEDLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11924 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3643
Mailing Address - Country:US
Mailing Address - Phone:813-926-2177
Mailing Address - Fax:813-926-7489
Practice Address - Street 1:11924 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3643
Practice Address - Country:US
Practice Address - Phone:813-926-2177
Practice Address - Fax:813-926-7489
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009456363LF0000X
FLARNP9473235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily