Healthcare Provider Details

I. General information

NPI: 1447655766
Provider Name (Legal Business Name): REGINALD PERARD APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W SAMPLE RD STE 244
COCONUT CREEK FL
33073-3473
US

IV. Provider business mailing address

4400 W SAMPLE RD STE 244
COCONUT CREEK FL
33073-3473
US

V. Phone/Fax

Practice location:
  • Phone: 561-740-6806
  • Fax: 855-300-5370
Mailing address:
  • Phone: 561-740-6806
  • Fax: 855-300-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN9325998
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9325998
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9325998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: