Provider Demographics
NPI:1023361441
Name:REBECCA REYNOLDS ARNP
Entity Type:Organization
Organization Name:REBECCA REYNOLDS ARNP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:727-244-5086
Mailing Address - Street 1:9035 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-4130
Mailing Address - Country:US
Mailing Address - Phone:727-244-5086
Mailing Address - Fax:877-422-2920
Practice Address - Street 1:9035 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-4130
Practice Address - Country:US
Practice Address - Phone:727-244-5086
Practice Address - Fax:877-422-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2736202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty