Provider Demographics
NPI:1033697776
Name:REYES, ANITA SUSAN (FNP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:SUSAN
Last Name:REYES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:CARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7931 OLYMPIA DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5788
Mailing Address - Country:US
Mailing Address - Phone:561-373-2540
Mailing Address - Fax:561-855-7293
Practice Address - Street 1:11327 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8724
Practice Address - Country:US
Practice Address - Phone:561-340-1615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9263558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily