Provider Demographics
NPI:1609663293
Name:SPA CITY VASCULAR AND WELLNESS PLLC
Entity type:Organization
Organization Name:SPA CITY VASCULAR AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:501-438-0111
Mailing Address - Street 1:1067 SEMINOLE RD
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:AR
Mailing Address - Zip Code:71929-6016
Mailing Address - Country:US
Mailing Address - Phone:501-229-4942
Mailing Address - Fax:
Practice Address - Street 1:3620 CENTRAL AVE STE E
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6090
Practice Address - Country:US
Practice Address - Phone:501-438-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty