Provider Demographics
NPI:1316699168
Name:REED, EMILY NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:REED
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:NICOLE
Other - Last Name:VANPUYMBROUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1463 NECTARINE STREET
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3027
Mailing Address - Country:US
Mailing Address - Phone:901-491-0177
Mailing Address - Fax:904-491-3173
Practice Address - Street 1:1463 NECTARINE STREET
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3027
Practice Address - Country:US
Practice Address - Phone:901-491-0177
Practice Address - Fax:904-491-3173
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015954208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics