MEDICARE: MIGUEL ANGEL MOLINA REYNOSO ARNP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11008335	FL

General Provider Information

NPI Number	:	1689283384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL ANGEL MOLINA REYNOSO ARNP

Provider Business Mailing Address
First Line	:	497 16TH AVE NE
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-2366
Country	:	US
Telephone Number	:	305-898-2207
Fax Number	:

Provider Business Practice Location Address
First Line	:	7211 VANDERBILT BEACH RD STE 12
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-1476
Country	:	US
Telephone Number	:	239-271-2497
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	07/28/2020

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