Healthcare Provider Details

I. General information

NPI: 1376458125
Provider Name (Legal Business Name): VERA LOUISE REAVES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR
TAMPA FL
33612-9416
US

IV. Provider business mailing address

12902 USF MAGNOLIA DR
TAMPA FL
33612-9416
US

V. Phone/Fax

Practice location:
  • Phone: 813-481-3821
  • Fax:
Mailing address:
  • Phone: 813-481-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11049250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: