Healthcare Provider Details

I. General information

NPI: 1912611856
Provider Name (Legal Business Name): JORDANA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 VETERANS PARK DR STE 2203
NAPLES FL
34109-0596
US

IV. Provider business mailing address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 239-431-5884
  • Fax: 239-631-6907
Mailing address:
  • Phone: 954-262-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9119538
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: