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General NPI Number Information
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NPI Number | 1083226724
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Entity Type | Individual
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Provider Name | JOACCY LAZO REYES ARNP
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Gender | Male
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Dates
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Enumeration Date | 08/22/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 2211 SE 15TH AVE
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City | CAPE CORAL
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State | FL
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Zip | 33990-4659
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Country | US
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Telephone | 239-888-2980
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 BROADWAY STE B-3
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City | FORT MYERS
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State | FL
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Zip | 33901-8193
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Country | US
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Telephone | 239-590-8571
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Fax | 239-590-8571
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11008293
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License Number State | FL
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