MEDICARE: MRS. ELIZABETH REYNOLDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	ARNP9280397	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174910970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH REYNOLDS

Provider Business Mailing Address
First Line	:	1603 SW THELMA STREET
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990
Country	:	US
Telephone Number	:	772-201-5463
Fax Number	:

Provider Business Practice Location Address
First Line	:	1603 SW THELMA STREET
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990
Country	:	US
Telephone Number	:	772-201-5463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	07/20/2015

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