Healthcare Provider Details

I. General information

NPI: 1992292106
Provider Name (Legal Business Name): MADELEINE MARIELA REYES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 HOLLYWOOD BOULEVARD #100-B
HOLLYWOOD FL
33021
US

IV. Provider business mailing address

5010 HOLLYWOOD BOULEVARD #100-B
HOLLYWOOD FL
33021
US

V. Phone/Fax

Practice location:
  • Phone: 954-697-0028
  • Fax:
Mailing address:
  • Phone: 954-697-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9393284
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209032153
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9393284
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: