Provider Demographics
NPI:1912295544
Name:REYES, ELISSE STEPHANIE (ARNP, PNP-BC, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ELISSE
Middle Name:STEPHANIE
Last Name:REYES
Suffix:
Gender:F
Credentials:ARNP, PNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW 170TH STREET
Mailing Address - Street 2:SUITE 410
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2518
Mailing Address - Country:US
Mailing Address - Phone:305-654-6850
Mailing Address - Fax:
Practice Address - Street 1:100 NW 170TH STREET
Practice Address - Street 2:SUITE 410
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-2518
Practice Address - Country:US
Practice Address - Phone:305-654-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9217589363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics