Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | ARNP9236660 | FL |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | ARNP9236660 | FL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP9236660 | FL |
NPI | 1144678723 |
---|---|
Provider Name | Desiree Reynolds |
First Address | Clermont, FL 34711-5333 |
Second Address | Orlando, FL 32806-1215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2016 |
Last Update Date | 24/05/2016 |