Individual
JACKIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1 TAMPA GENERAL CIR, SUITE G415, TAMPA, FL 33606-3571
(813) 844-7968
(813) 844-4049
Mailing address
PO BOX 1289, TAMPA, FL 33601-1289
(813) 844-7968
(813) 844-4049
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP030875
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307290800
—
FL
01
—
Y086N
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/30/2006
Last updated
10/16/2025
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