Healthcare Provider Details

I. General information

NPI: 1033503438
Provider Name (Legal Business Name): SAMANTHA D REYNOLDS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH PARK BLVD STE 3002
SAINT AUGUSTINE FL
32086-3703
US

IV. Provider business mailing address

300 HEALTH PARK BLVD STE 3002
SAINT AUGUSTINE FL
32086-3703
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-1500
  • Fax: 904-810-1023
Mailing address:
  • Phone: 904-819-1500
  • Fax: 904-810-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9233956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: