Provider Demographics
NPI:1043701238
Name:SMITH, ERIN JEANNE DEMARCO (MS, RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:JEANNE DEMARCO
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 COVE RD
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8750
Mailing Address - Country:US
Mailing Address - Phone:954-240-6301
Mailing Address - Fax:
Practice Address - Street 1:2519 COVE RD
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-8750
Practice Address - Country:US
Practice Address - Phone:954-240-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FL7514133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104113700Medicaid