Individual
DIEDRE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9624 MAXSON DRIVE, LAND O LAKES, FL 34638
(813) 751-4718
Mailing address
9624 MAXSON DR, LAND O LAKES, FL 34638-6973
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9419981
FL
163WC1500X
Community Health Registered Nurse
RN9419981
FL
172V00000X
Community Health Worker
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
RN9419981
FL
Other
Enumeration date
11/19/2015
Last updated
08/15/2016
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