1013216043 NPI number — DR. MARGARET LOUISE REYNOLDS PRINCE ED. D.

Table of content: DR. MARGARET LOUISE REYNOLDS PRINCE ED. D. (NPI 1013216043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013216043 NPI number — DR. MARGARET LOUISE REYNOLDS PRINCE ED. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNOLDS PRINCE
Provider First Name:
MARGARET
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ED. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REYNOLDS PRINCE
Provider Other First Name:
MARGARET
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ED. D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1013216043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 3RD ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33701-3819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-828-8362
Provider Business Mailing Address Fax Number:
727-823-8082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 4TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33701-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-828-8362
Provider Business Practice Location Address Fax Number:
727-823-8082
Provider Enumeration Date:
03/16/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH10648 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)