Provider Demographics
NPI:1073180147
Name:CHARLES ROY, REGINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:CHARLES ROY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6187 NW 167TH ST STE H23
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4352
Mailing Address - Country:US
Mailing Address - Phone:954-881-3710
Mailing Address - Fax:866-456-9976
Practice Address - Street 1:6187 NW 167TH ST STE H23
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4352
Practice Address - Country:US
Practice Address - Phone:954-881-3710
Practice Address - Fax:866-456-9976
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP000184363LF0000X
FLAPRN11012171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily