Provider Demographics
NPI:1457309411
Name:REYNOLDS, TATIANA STEPANOVA (MD)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:STEPANOVA
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 172181
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33672-0181
Mailing Address - Country:US
Mailing Address - Phone:855-421-2733
Mailing Address - Fax:760-280-0234
Practice Address - Street 1:119 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5779
Practice Address - Country:US
Practice Address - Phone:407-788-1906
Practice Address - Fax:321-280-2479
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 93224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI34727Medicare UPIN