Provider Demographics
NPI:1447653027
Name:BRAGG, REYNA Q (DOM AP)
Entity type:Individual
Prefix:DR
First Name:REYNA
Middle Name:Q
Last Name:BRAGG
Suffix:
Gender:F
Credentials:DOM AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 SUN CITY CENTER PLZ STE 202B2
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5373
Mailing Address - Country:US
Mailing Address - Phone:941-301-6940
Mailing Address - Fax:
Practice Address - Street 1:3040 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570
Practice Address - Country:US
Practice Address - Phone:813-331-3940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3445171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1447653027OtherACUPUNCTURE