Individual
CRYSTAL K SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
508 64TH AVE E, BRADENTON, FL 34203-7643
(941) 536-3600
Mailing address
508 64TH AVE E, BRADENTON, FL 34203-7643
(941) 536-3600
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134340833
—
FL
Enumeration date
01/30/2019
Last updated
01/30/2019
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