Individual
MS. AMANDA LUCILLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
4235 SECOR RD, TOLEDO, OH 43623-4299
(419) 593-0050
Mailing address
4235 SECOR RD, TOLEDO, OH 43623-4299
(419) 473-3561
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.005136RX
OH
363A00000X
Physician Assistant
MA055640
PA
363A00000X
Physician Assistant
PA9104163
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0277704
—
OH
01
—
50.005136RX
OHIO MEDICAL LICENSE
OH
Enumeration date
05/06/2008
Last updated
08/15/2025
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