Provider Demographics
NPI:1508566605
Name:RODEN-REYNOLDS, MICHAEL CARL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CARL
Last Name:RODEN-REYNOLDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:PO BOX 100236
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0236
Mailing Address - Country:US
Mailing Address - Phone:352-273-5550
Mailing Address - Fax:352-273-5575
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-1134
Practice Address - Country:US
Practice Address - Phone:352-273-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9117422363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant