Provider Demographics
NPI:1720754948
Name:REYES-PHILLIP, MAYRA S (CNA)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:S
Last Name:REYES-PHILLIP
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E SILVER SPRINGS BLVD STE 127
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6833
Mailing Address - Country:US
Mailing Address - Phone:352-502-4923
Mailing Address - Fax:352-504-0241
Practice Address - Street 1:1515 E SILVER SPRINGS BLVD STE 127
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6833
Practice Address - Country:US
Practice Address - Phone:352-502-4923
Practice Address - Fax:352-504-0241
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1883073376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide