Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AG03190022 | FL |
NPI | 1043778947 |
---|---|
Provider Name | Gabrielle Maureen Reynolds |
First Address | Miramar, FL 33027-6053 |
Second Address | Miramar, FL 33027-6053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2019 |
Last Update Date | 25/06/2019 |