Provider Demographics
NPI:1689417560
Name:REYNOSO, GUISELLA KARINA (FNP)
Entity type:Individual
Prefix:MRS
First Name:GUISELLA
Middle Name:KARINA
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 LIVVY LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6662
Mailing Address - Country:US
Mailing Address - Phone:843-453-4988
Mailing Address - Fax:
Practice Address - Street 1:400 LEM MORRISON DRIVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849-0001
Practice Address - Country:US
Practice Address - Phone:334-844-6157
Practice Address - Fax:334-844-6111
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-189686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily