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NPI Code Detail

MEDICARE: NICOLE REYNAGA

MEDICARE: NICOLE REYNAGA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103K00000XBehavior Analyst1-21-52552FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306344890
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE REYNAGA
Provider Business Mailing Address
First Line : 7108 S KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34997-7462
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Provider Business Practice Location Address
First Line : 1909 HILLBROOKE TRL STE 3
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32311-7902
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2018
Last Update Date : 10/01/2021

Similar Medicare Providers

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Practice Location Address:
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1205293412 — MRS. DANIELLE E SHELTON MM, MT-BC, CEDCAT
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Practice Fax: 850-270-6932
1053830844 — CAROLINA CERRA
Practice Location Address:
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TALLAHASSEE, FL
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Practice Fax: 772-675-9100
1780240416 — KERI WINKLER
Practice Location Address:
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TALLAHASSEE, FL
32311-7902
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Practice Fax:
1275144172 — NAILAH T BUSH
Practice Location Address:
1909 HILLBROOKE TRL STE 3
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Directions to “ NICOLE REYNAGA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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