1982902904 NPI number — MRS. TERICKA SMITH CESAR ANP

Table of content: MRS. TERICKA SMITH CESAR ANP (NPI 1982902904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982902904 NPI number — MRS. TERICKA SMITH CESAR ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CESAR
Provider First Name:
TERICKA
Provider Middle Name:
SMITH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CESAR
Provider Other First Name:
TERI
Provider Other Middle Name:
SMITH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ANP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1982902904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3550 NW 194TH TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33056-2230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-509-5733
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3550 NW 194TH TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33056-2230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-509-5733
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  15594 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: 9320003 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)