MEDICARE: REGINA PROVIDING CARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	30212811	OTHER	FL	NURSE REGISTRY LICENSE

General Provider Information

NPI Number	:	1427881580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGINA PROVIDING CARE INC.

Provider Business Mailing Address
First Line	:	800 VIRGINIA AVE STE 42
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5893
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 VIRGINIA AVE STE 42
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5893
Country	:	US
Telephone Number	:	772-323-0055
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	REGINA R. DONALDSON
Credential	:
Telephone Number	:	772-323-0055

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	08/28/2024

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Directions to “REGINA PROVIDING CARE INC. ” Practice Location

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