Provider Demographics
NPI:1023273232
Name:REYNOLDS, TINA MARIE (NP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:3000 S MCCALL RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-8616
Practice Address - Country:US
Practice Address - Phone:941-841-4200
Practice Address - Fax:941-841-4201
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2024-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002316363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health