Healthcare Provider Details

I. General information

NPI: 1245195650
Provider Name (Legal Business Name): R&R MEDSPA AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 E COBB AVE
CRESTVIEW FL
32539-4212
US

IV. Provider business mailing address

246 E COBB AVE
CRESTVIEW FL
32539-4212
US

V. Phone/Fax

Practice location:
  • Phone: 850-598-9939
  • Fax:
Mailing address:
  • Phone: 850-598-9939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS PATRICK REEDER
Title or Position: OWNER OPERATOR
Credential: FNP, ARNP
Phone: 850-598-9939