Provider Demographics
NPI:1508596784
Name:SCOTT, REBA LEEANN (DOULA)
Entity Type:Individual
Prefix:
First Name:REBA
Middle Name:LEEANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 9TH ST NE
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:FL
Mailing Address - Zip Code:33841-2226
Mailing Address - Country:US
Mailing Address - Phone:863-333-2924
Mailing Address - Fax:
Practice Address - Street 1:804 9TH ST NE
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:FL
Practice Address - Zip Code:33841-2226
Practice Address - Country:US
Practice Address - Phone:863-333-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374J00000XMedicaid