Healthcare Provider Details

I. General information

NPI: 1770320053
Provider Name (Legal Business Name): ERIN REGALADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11555 CENTRAL PKWY STE 304
JACKSONVILLE FL
32224-2694
US

IV. Provider business mailing address

11555 CENTRAL PKWY STE 304
JACKSONVILLE FL
32224-2694
US

V. Phone/Fax

Practice location:
  • Phone: 904-201-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11033182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: