Provider Demographics
NPI:1033531660
Name:DESIRE, REGINE (NURSE)
Entity Type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:DESIRE
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 BAHAMA DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5959
Mailing Address - Country:US
Mailing Address - Phone:786-370-8266
Mailing Address - Fax:
Practice Address - Street 1:3304 BAHAMA DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5959
Practice Address - Country:US
Practice Address - Phone:786-370-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9315727163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse