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Organization
P31 LIFE
Active
Organization
P31 LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANNE KELLY SMITH DNP, APRN, FPMHNP-BC (OWNER)
(850) 299-9943
Entity
Organization
Contact information
Practice address
4591 E HIGHWAY 20 STE 202, NICEVILLE, FL 32578-8845
(850) 299-9943
(863) 594-1643
Mailing address
4516 E HIGHWAY 20 # 168, NICEVILLE, FL 32578-9755
(850) 299-9943
(863) 594-1643
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/16/2021
Last updated
07/28/2026
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