Provider Demographics
NPI:1346868320
Name:REYNOLDS, PAOLA ANDREA (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PAOLA
Middle Name:ANDREA
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:MS
Other - First Name:PAOLA
Other - Middle Name:ANDREA
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:390 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3456
Mailing Address - Country:US
Mailing Address - Phone:321-633-3162
Mailing Address - Fax:
Practice Address - Street 1:390 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3456
Practice Address - Country:US
Practice Address - Phone:321-633-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007865363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily