Healthcare Provider Details

I. General information

NPI: 1962335976
Provider Name (Legal Business Name): YANET ANNIA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 FAIRWAY BLVD
PANAMA CITY BEACH FL
32407-2809
US

IV. Provider business mailing address

307 FAIRWAY BLVD
PANAMA CITY BEACH FL
32407-2809
US

V. Phone/Fax

Practice location:
  • Phone: 305-731-4309
  • Fax:
Mailing address:
  • Phone: 305-731-4309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11047793
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: