MEDICARE: JORDANA REYES

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	363AM0700X	Medical Physician Assistant	PA9119538	FL

General Provider Information

NPI Number	:	1912611856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDANA REYES

Provider Business Mailing Address
First Line	:	3200 S UNIVERSITY DR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33328-2018
Country	:	US
Telephone Number	:	954-262-1250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1875 VETERANS PARK DR STE 2203
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-0596
Country	:	US
Telephone Number	:	239-431-5884
Fax Number	:	239-631-6907

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

Provider Enumeration Date	:	01/05/2023
Last Update Date	:	01/10/2025

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Directions to “ JORDANA REYES ” Practice Location

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