Healthcare Provider Details

I. General information

NPI: 1255263802
Provider Name (Legal Business Name): TANANYA REID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 RASPBERRY RD
FORT PIERCE FL
34981-5361
US

IV. Provider business mailing address

510 RASPBERRY RD
FORT PIERCE FL
34981-5361
US

V. Phone/Fax

Practice location:
  • Phone: 954-536-0379
  • Fax:
Mailing address:
  • Phone: 954-536-0379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11046870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: