Provider Demographics
NPI:1003332685
Name:REGO, ASTI ELIZABETH (FNP)
Entity Type:Individual
Prefix:
First Name:ASTI
Middle Name:ELIZABETH
Last Name:REGO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 HANSEN MANOR LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-2858
Mailing Address - Country:US
Mailing Address - Phone:702-956-2784
Mailing Address - Fax:
Practice Address - Street 1:802 N BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2103
Practice Address - Country:US
Practice Address - Phone:727-447-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9449253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily