Healthcare Provider Details

I. General information

NPI: 1619832060
Provider Name (Legal Business Name): SANDRA MAE REYNOLDS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 CRESCENT PARK DR
RIVERVIEW FL
33578-3625
US

IV. Provider business mailing address

3905 CRESCENT PARK DR
RIVERVIEW FL
33578-3625
US

V. Phone/Fax

Practice location:
  • Phone: 813-580-5000
  • Fax:
Mailing address:
  • Phone: 813-580-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11045075
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: