Basic Information
| Provider Information | |||||||||
| NPI: | 1235399486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RENO | ||||||||
| FirstName: | NATALIYA | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 137 HOSPITAL DR. NE | ||||||||
| Address2: | |||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508337400 | ||||||||
| FaxNumber: | 8508337439 | ||||||||
| Practice Location | |||||||||
| Address1: | 137 HOSPITAL DR. NE | ||||||||
| Address2: | |||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508337400 | ||||||||
| FaxNumber: | 8508337439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2008 | ||||||||
| LastUpdateDate: | 04/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP 9235839 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0808X | ARNP 9235839 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 2797667 | 01 | FL | CIGNA | OTHER | 004067800 | 05 | FL | MEDICAID | 9141702 | 01 | FL | AETNA | OTHER | Y06LN | 01 | FL | BCBS | OTHER |