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Individual

MRS. ITZEL SANDOVAL-REYNOSO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
380 PINE LEAF DR, ST AUGUSTINE, FL 32092-1462
(904) 707-3147
Mailing address
380 PINE LEAF DR, ST AUGUSTINE, FL 32092-1462
(904) 707-3147

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9115077
FL
363AM0700X
Medical Physician Assistant
PA9115077
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
112060700
FL
Enumeration date
09/17/2021
Last updated
11/21/2025
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