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General NPI Number Information
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NPI Number | 1609663293
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Entity Type | Organization
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Legal Business Name | SPA CITY VASCULAR AND WELLNESS PLLC
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 3620 CENTRAL AVE STE E
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City | HOT SPRINGS
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State | AR
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Zip | 71913-6090
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Country | US
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Telephone | 501-438-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 1067 SEMINOLE RD
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City | BISMARCK
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State | AR
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Zip | 71929-6016
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Country | US
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Telephone | 501-229-4942
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Fax |
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Authorized Official
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Title or Position | APRN OWNER
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Name | MRS. SARAH REYNA
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Credential | APRN
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Telephone | 501-438-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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