Healthcare Provider Details

I. General information

NPI: 1598671331
Provider Name (Legal Business Name): REGINE E THEARD ADVANCED NURSE PRACT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11345 NW 43RD PL
CORAL SPRINGS FL
33065-7220
US

IV. Provider business mailing address

11345 NW 43RD PL
CORAL SPRINGS FL
33065-7220
US

V. Phone/Fax

Practice location:
  • Phone: 954-242-6735
  • Fax:
Mailing address:
  • Phone: 954-242-6735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11050137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: