Healthcare Provider Details

I. General information

NPI: 1700849825
Provider Name (Legal Business Name): REGINA ALLEN HARDIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. REGINA DENISE ALLEN

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 66TH ST N STE 11
PINELLAS PARK FL
33781-2111
US

IV. Provider business mailing address

8130 66TH ST N STE 11
PINELLAS PARK FL
33781-2111
US

V. Phone/Fax

Practice location:
  • Phone: 727-265-1353
  • Fax: 727-265-1353
Mailing address:
  • Phone: 727-265-1353
  • Fax: 570-202-9973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number045033
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: