Healthcare Provider Details

I. General information

NPI: 1336611995
Provider Name (Legal Business Name): REGINE JOLY RN, MPH, CHES, CCM,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REGINE JEAN-PIERRE RN

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8895 SW 136TH ST
MIAMI FL
33176-5816
US

IV. Provider business mailing address

17521 SW 93RD PL
PALMETTO BAY FL
33157-5768
US

V. Phone/Fax

Practice location:
  • Phone: 305-256-5480
  • Fax:
Mailing address:
  • Phone: 305-256-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN2005292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: