Wave dispersion response of a fluid-carrying piezoelectric nanotube is studied in this paper utilizing an improved model for piezoelectric materials which capture a new effect known as flexoelectricity in conjunction with the surface elasticity. For this aim, a higher order shear deformation theory is employed to model the problem. Furthermore, strain gradient effect as well as nonlocal effect is taken into consideration throughout using the nonlocal strain gradient theory (NSGT). Surface elasticity is also considered to make an accurate size-dependent formulation. Additionally, a non-compressible and non-viscous fluid is taken into consideration to model the flow effect. The wave propagation solution is then implemented to the governing equations obtained by Hamiltonian’s approach. The phase velocity and group velocity of the nanotube is determined for three wave modes (i.e. shear, longitudinal and bending waves) to study the influence of various involved factors including strain gradient, nonlocality, flexoelectricity and surface elasticity and flow velocity on the wave dispersion curves. Results reveal a considerable effect of the flexoelectric phenomenon on the wave propagation properties especially at a specific domain of the wave number. The size-dependency of this effect is disclosed. Overall, it is found that the flexoelectricity exhibits a substantial influence on wave dispersion properties of the smart fluid-conveying systems. Hence, such size-dependent effect should be considered to achieve exact and accurate knowledge on wave propagation characteristics of the system.