Provider Demographics
NPI:1285217232
Name:BISHOP, REANNE
Entity Type:Individual
Prefix:
First Name:REANNE
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 SAINT JOHNS PKWY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6370
Mailing Address - Country:US
Mailing Address - Phone:407-710-3116
Mailing Address - Fax:
Practice Address - Street 1:3840 SAINT JOHNS PKWY
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-6370
Practice Address - Country:US
Practice Address - Phone:407-710-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107352100Medicaid