Provider Demographics
NPI:1740874569
Name:SMITH, MORGAN G (PA-C)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W COPELAND DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2101
Mailing Address - Country:US
Mailing Address - Phone:321-843-8979
Mailing Address - Fax:321-843-2267
Practice Address - Street 1:125 W COPELAND DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2101
Practice Address - Country:US
Practice Address - Phone:321-843-8979
Practice Address - Fax:321-843-2267
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9117472363AM0700X
FLPA9117472363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL121355300Medicaid