Healthcare Provider Details

I. General information

NPI: 1942111521
Provider Name (Legal Business Name): GABRIELLA MARIE REAGAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11635 NORTHPARK DR STE 200
WAKE FOREST NC
27587-9350
US

IV. Provider business mailing address

11635 NORTHPARK DR STE 200
WAKE FOREST NC
27587-9350
US

V. Phone/Fax

Practice location:
  • Phone: 919-570-6060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5025389
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: