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General NPI Number Information
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NPI Number | 1912472713
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Entity Type | Individual
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Provider Name | ELINA SERGEYEVNA REYNOLDS NP
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Gender | Female
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 5650 VIRGINIA BEACH BLVD STE 104
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-5687
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Country | US
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Telephone | 757-770-3444
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Fax | 757-208-1378
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Provider Business Mailing Address
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Address Line | 5650 VIRGINIA BEACH BLVD STE 104
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-5687
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Country | US
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Telephone | 757-770-3444
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Fax | 757-208-1378
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0024176433
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License Number State | VA
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