Individual
WILLESHA TREVESS SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5684 ELSINORE WAY, LAKELAND, FL 33805-2660
(863) 617-3689
Mailing address
5684 ELSINORE WAY, LAKELAND, FL 33805-2660
(863) 617-3689
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024490600
—
FL
Enumeration date
01/03/2020
Last updated
01/03/2020
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