Provider Demographics
NPI:1255311965
Name:SIBAL, REGINA R (LNP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:R
Last Name:SIBAL
Suffix:
Gender:F
Credentials:LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 MAGIC HOLLOW BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-3077
Mailing Address - Country:US
Mailing Address - Phone:757-471-2348
Mailing Address - Fax:757-493-5456
Practice Address - Street 1:3143 MAGIC HOLLOW BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-3077
Practice Address - Country:US
Practice Address - Phone:757-471-2348
Practice Address - Fax:757-493-5456
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945395Medicaid
VA004945395Medicaid