Healthcare Provider Details

I. General information

NPI: 1316879653
Provider Name (Legal Business Name): REAGAN WELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E SOUTH ST
STARKE FL
32091-4059
US

IV. Provider business mailing address

115 E SOUTH ST
STARKE FL
32091-4059
US

V. Phone/Fax

Practice location:
  • Phone: 904-452-1850
  • Fax:
Mailing address:
  • Phone: 904-452-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: