Provider Demographics
NPI:1336538735
Name:REYES, EVIDIO JORGE (FNP-C)
Entity type:Individual
Prefix:
First Name:EVIDIO
Middle Name:JORGE
Last Name:REYES
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9835 SUNSET DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4648
Mailing Address - Country:US
Mailing Address - Phone:786-937-9835
Mailing Address - Fax:786-937-9834
Practice Address - Street 1:9835 SUNSET DR STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4648
Practice Address - Country:US
Practice Address - Phone:786-937-9835
Practice Address - Fax:786-937-9834
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily