Healthcare Provider Details

I. General information

NPI: 1023273232
Provider Name (Legal Business Name): TINA MARIE REYNOLDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 S MCCALL RD
ENGLEWOOD FL
34224-8616
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 941-841-4200
  • Fax: 941-841-4201
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11002316
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: