Healthcare Provider Details

I. General information

NPI: 1467400085
Provider Name (Legal Business Name): MARIA R REGALA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MICCOSUKEE RD
TALLAHASSEE FL
32308-5054
US

IV. Provider business mailing address

1300 MICCOSUKEE RD
TALLAHASSEE FL
32308-5054
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-5354
  • Fax: 850-431-6061
Mailing address:
  • Phone: 850-431-5354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberRN1962052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: