Healthcare Provider Details

I. General information

NPI: 1144009408
Provider Name (Legal Business Name): REGINE MILLIEN-POLK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 10/07/2023
Certification Date: 10/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 GOLDEN POPPY CT
ORLANDO FL
32824-6441
US

IV. Provider business mailing address

1611 GOLDEN POPPY CT
ORLANDO FL
32824-6441
US

V. Phone/Fax

Practice location:
  • Phone: 407-844-7437
  • Fax:
Mailing address:
  • Phone: 407-844-7437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN9454817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: