Basic Information
| Provider Information | |||||||||
| NPI: | 1649756719 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | GUILLENNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSN,APRN-FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 CLEMATIS ST STE 5-531 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334015107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616714036 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 245 SOUTH CONGRESS AVENUE | ||||||||
| Address2: | FLORIDA DEPARTMENT OF HEALTH-DELRAY BEACH HEALTH CENTER | ||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612743100 | ||||||||
| FaxNumber: | 5612666629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2018 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 9254635 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 363L0000X | 05 | FL | MEDICAID |