=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336946821
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOEMI D REYES RAMOS APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2025
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28220 PINE HAVEN WAY APT 58
-----------------------------------------------------
City | BONITA SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34135-0804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-831-4110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28220 PINE HAVEN WAY APT 58
-----------------------------------------------------
City | BONITA SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34135-0804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-831-4110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 11037869
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------