MEDICARE: NICOLE M. REYNOLDS CNP

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	163W00000X	Registered Nurse	RN.411828	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.0029566	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1700355088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE M. REYNOLDS CNP

Provider Business Mailing Address
First Line	:	18697 BAGLEY RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3417
Country	:	US
Telephone Number	:	440-816-2491
Fax Number	:	440-816-4609

Provider Business Practice Location Address
First Line	:	7801 DETROIT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2813
Country	:	US
Telephone Number	:	216-634-7400
Fax Number	:	216-634-7483

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

Provider Enumeration Date	:	11/16/2018
Last Update Date	:	01/13/2026

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