Individual
TINA DIANNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
279 E KENNEDY ST, SPARTANBURG, SC 29302-1912
(864) 583-0053
Mailing address
PO BOX 6130, SPARTANBURG, SC 29304-6130
(864) 583-0053
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
22471
SC
Other
Enumeration date
10/27/2019
Last updated
11/08/2019
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