Basic Information
| Provider Information | |||||||||
| NPI: | 1659932465 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMIDDY | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1461 PATRIOT LN | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478027709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122392854 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1513 N 6TH 1/2 ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478071039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122423125 | ||||||||
| FaxNumber: | 8122423446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2019 | ||||||||
| LastUpdateDate: | 07/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F06191147 | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.