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Active NPI 1356011514 Individual Practitioner Female Practitioner

Itzel Sandoval-Reynoso , PA-C

Physician Assistant • St Augustine, FL

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Itzel Sandoval-Reynoso, PA-C is a certified Physician Assistant practicing in St Augustine, FL. With approximately 5 years of clinical experience since graduating from Nova Southeastern College Of Osteo Medicine in 2021, Itzel Sandoval-Reynoso delivers high-quality medical care to the local community at 380 PINE LEAF DR.

Itzel Sandoval-Reynoso is affiliated with Mayo Clinic Jacksonville and accepts Medicare assignment.

Practice Location & Contact Primary Location

Practice Address

380 Pine Leaf Dr

St Augustine, FL 320921462

Telephone 9047073147

Medicare Profile & Education

Medical School

Nova Southeastern College Of Osteo Medicine

Graduation Year

2021

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in St Augustine, FL

Experienced Practitioner (5-10 Yrs)
Practitioner Clinical Experience
5 Yrs -6.1 yrs vs City Avg
City Avg: 11.1 Yrs
State Avg: 11.1 Yrs
Regional Practice Density
41 Specialists

Practicing in St Augustine, FL (10376 Statewide)

Telehealth Adoption Rate
2.4% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Sandoval-Reynoso (5 Years) 5 Yrs
St Augustine Specialty Average (11.1 Years) 11.1 Yrs

Medical Specialties & State Licenses

CMS Verified: 2025-11-21
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License FL PA9115077

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Physician Assistant - Medical

NUCC Taxonomy Code: 363AM0700X

State License FL PA9115077

Definition to come...

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
112060700 (FL)

Hospital & Practice Group Affiliations

Mayo Clinic Jacksonville

4500 San Pablo Rd S, Jacksonville, FL 322241865

Phone: 9049532000

Secondary Practice Locations

4500 San Pablo Rd S

Jacksonville, FL 322241865

Phone: 9049532000

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

15 Historical Events
📍
Updated Practice Location September 30, 2025

Registered at 380 PINE LEAF DR, ST AUGUSTINE, FL 320921462 (Tel: 9047073147)

📍
Updated Business Mailing Address September 30, 2025

Registered at 380 PINE LEAF DR, ST AUGUSTINE, FL 320921462 (Tel: 9047073147)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 30, 2025

Physician Assistant (License #PA9115077 in FL)

📍
Updated Practice Location June 17, 2025

Registered at 327 HICKORY HOLLOW DR N, JACKSONVILLE, FL 322253057 (Tel: 9047073147)

📍
Updated Business Mailing Address June 17, 2025

Registered at 327 HICKORY HOLLOW DR N, JACKSONVILLE, FL 322253057 (Tel: 9047073147)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 17, 2025

Physician Assistant

📍
Updated Practice Location April 04, 2022

Registered at 1215 DUNN AVE STE 1, JACKSONVILLE, FL 322184897 (Tel: 9046967474)

📍
Updated Business Mailing Address April 04, 2022

Registered at 6520 FORT CAROLINE RD, JACKSONVILLE, FL 322772044 (Tel: 9047453618)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 04, 2022

Physician Assistant (License #PA9115077 in FL)

NPI Profile Active October 06, 2021

NPI status registered as active in NPPES database

📍
Updated Practice Location October 06, 2021

Registered at 1201 MONUMENT RD STE 200, JACKSONVILLE, FL 322257428 (Tel: 9047275151)

📍
Updated Business Mailing Address October 06, 2021

Registered at 2675 WINKLER AVE FL 2, FORT MYERS, FL 339019342 (Tel: 8778563774)

👤
Provider Name / Credentials Updated October 06, 2021

Recorded as ITZEL SANDOVAL-REYNOSO, PA-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 06, 2021

Physician Assistant

🟢
Initial NPI Registration & Enumeration September 17, 2021

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1356011514
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 17, 2021
Last Update: November 21, 2025
Sole Proprietor: No

Mailing Address

380 Pine Leaf Dr

St Augustine, FL 320921462

Phone: 9047073147

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.