Provider Demographics
NPI:1093240335
Name:NAZAIRE, REGINALD J (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:J
Last Name:NAZAIRE
Suffix:
Gender:M
Credentials:REGISTERED 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 BALBOA WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665
Mailing Address - Country:US
Mailing Address - Phone:512-573-0929
Mailing Address - Fax:512-856-9483
Practice Address - Street 1:3304 BALBOA WAY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2252
Practice Address - Country:US
Practice Address - Phone:512-600-3383
Practice Address - Fax:512-856-9483
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336043164W00000X
FL9600544163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34669471OtherDRIVER LICENSE