Provider Demographics
NPI:1477142719
Name:NODARSE REYES, JUANA LILIAM (APRN 11030149)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:LILIAM
Last Name:NODARSE REYES
Suffix:
Gender:F
Credentials:APRN 11030149
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 SUGARBUSH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-0121
Mailing Address - Country:US
Mailing Address - Phone:407-399-3862
Mailing Address - Fax:
Practice Address - Street 1:571 SUGARBUSH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-0121
Practice Address - Country:US
Practice Address - Phone:407-399-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily