Provider Demographics
NPI:1003939349
Name:REAGAN, JANEANE (PHD)
Entity Type:Individual
Prefix:
First Name:JANEANE
Middle Name:
Last Name:REAGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S EVERS ST
Mailing Address - Street 2:STE 104
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-5403
Mailing Address - Country:US
Mailing Address - Phone:813-754-7756
Mailing Address - Fax:813-754-7565
Practice Address - Street 1:510 COUNTY ROAD 466
Practice Address - Street 2:STE 207M
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-4202
Practice Address - Country:US
Practice Address - Phone:352-643-0126
Practice Address - Fax:352-753-4034
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7470103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY7470OtherMEDICAL LICENSE #
FLAF785Medicare PIN