Provider Demographics
NPI:1811241029
Name:REYES, JEANETTE ANASTACIA (APRN)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:ANASTACIA
Last Name:REYES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 SE OCEAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2425
Mailing Address - Country:US
Mailing Address - Phone:772-888-1880
Mailing Address - Fax:
Practice Address - Street 1:931 SE OCEAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2425
Practice Address - Country:US
Practice Address - Phone:772-888-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9241675363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner