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General NPI Number Information
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NPI Number | 1487470464
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Entity Type | Individual
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Provider Name | REGINE DE LA PENA FNP
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Gender | Female
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 10/04/2025
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Provider Practice Location Address
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Address Line | 89 BARTLETT ST
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City | BROOKLYN
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State | NY
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Zip | 11206-4463
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Country | US
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Telephone | 718-828-2666
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Fax |
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Provider Business Mailing Address
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Address Line | 321 N WARREN ST
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City | TRENTON
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State | NJ
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Zip | 08618-4794
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Country | US
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Telephone | 609-278-5905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15347200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 766401
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License Number State | NY
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