Provider Demographics
NPI:1144678723
Name:REYNOLDS, DESIREE (MSN-ED, APRN-C)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MSN-ED, APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 BEACON RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5333
Mailing Address - Country:US
Mailing Address - Phone:352-394-2616
Mailing Address - Fax:
Practice Address - Street 1:444 W NEW ENGLAND AVE STE 121
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4376
Practice Address - Country:US
Practice Address - Phone:407-644-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9236660363L00000X, 363LC0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine