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NPI Code Detail

MEDICARE: MS. LATRISTA REYNOLDS FNP

MEDICARE: MS. LATRISTA REYNOLDS FNP
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
1363LF0000XFamily Nurse PractitionerARNP9270008FL
2363LP0808XPsychiatric/Mental Health Nurse PractitionerARPN927008FL

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 : 1740616390
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LATRISTA REYNOLDS FNP
Provider Business Mailing Address
First Line : 5905 US HIGHWAY 301 S
Second Line :
City : RIVERVIEW
State : FL
Zip : 33578-3800
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5905 US HIGHWAY 301 S
Second Line :
City : RIVERVIEW
State : FL
Zip : 33578-3800
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2013
Last Update Date : 08/22/2024

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