Provider Demographics
NPI:1447373337
Name:SMITH, ERIN NICOLE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:NICOLE
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 1:1598 KAY AVE
Mailing Address - Street 2:APT. A
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-6897
Mailing Address - Country:US
Mailing Address - Phone:352-256-2752
Mailing Address - Fax:
Practice Address - Street 1:1511 SURGEONS DR
Practice Address - Street 2:SUITE A
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4632
Practice Address - Country:US
Practice Address - Phone:850-878-6134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103851363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant