Provider Demographics
NPI:1013554138
Name:RENSHAW, REANNA (ARNP)
Entity Type:Individual
Prefix:
First Name:REANNA
Middle Name:
Last Name:RENSHAW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 S LAKELAND DR STE 2
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2599
Mailing Address - Country:US
Mailing Address - Phone:863-232-4323
Mailing Address - Fax:863-337-5728
Practice Address - Street 1:5129 S LAKELAND DR STE 2
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2599
Practice Address - Country:US
Practice Address - Phone:863-232-4323
Practice Address - Fax:863-337-5728
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily