| Doctor Name: | DR. MICHELLE RENEE REILLO |
| NPI Number: | 1275846420 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, NP, PHD |
| License Number: | RN 9303002 |
| Business Practice Address: | 129 Seagrove Main Street 202 St. Augustine, FL - 32080 |
| Business Phone Number: | 8042964094 |
| Business Fax Number: | 9042170153 |
| Mailing Address: | 129 Seagrove Main Street, Unit 202 ST. AUGUSTINE |
| State: | FL |
| Postal Code: | 32080 |
| Phone Number: | 8042964094 |
| Fax Number: | 9042170153 |
| NPI Enumeration Date: | 07/16/2010 |
| NPI Last Update Date: | 01/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | RN 9303002 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |