Basic Information
Provider Information
NPI: 1356780787
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REED
FirstName: AMY
MiddleName: JEAN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 601 S HARBOUR ISLAND BLVD STE 200
Address2:  
City: TAMPA
State: FL
PostalCode: 336025925
CountryCode: US
TelephoneNumber: 7273223439
FaxNumber: 8009287449
Practice Location
Address1: 6675 PINE FOREST RD UNIT 6
Address2:  
City: PENSACOLA
State: FL
PostalCode: 325269179
CountryCode: US
TelephoneNumber: 8503782572
FaxNumber: 8443886186
Other Information
ProviderEnumerationDate: 06/19/2013
LastUpdateDate: 08/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XME144705FLY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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