Individual
ETHAN PAUL REID
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
1839 CENTRAL AVE., ST. PETERSBURG, FL 33713-8900
(727) 322-1054
(727) 821-7213
Mailing address
1839 CENTRAL AVE., ST. PETERSBURG, FL 33713-8900
(727) 322-1054
(727) 821-7213
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN9283538
FL
363LA2200X
Adult Health Nurse Practitioner
ARNP9283538
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022437600
—
FL
01
—
S59UH
BCBS
FL
Enumeration date
09/14/2017
Last updated
04/14/2022
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