Provider Demographics
NPI:1427815166
Name:REAGAN, BIANCA LACEY (ARNP)
Entity type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:LACEY
Last Name:REAGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 LAKEWOOD PRESERVE PL
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9276
Mailing Address - Country:US
Mailing Address - Phone:954-298-0192
Mailing Address - Fax:
Practice Address - Street 1:12105 LAKEWOOD PRESERVE PL
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-9276
Practice Address - Country:US
Practice Address - Phone:954-298-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031394363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner