Provider Demographics
NPI:1275162216
Name:ALUISE, REGINA MARIE
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:ALUISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 CAMDEN HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-9311
Mailing Address - Country:US
Mailing Address - Phone:941-704-5662
Mailing Address - Fax:
Practice Address - Street 1:10931 RAVEN RIDGE RD STE 115
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6499
Practice Address - Country:US
Practice Address - Phone:919-676-0202
Practice Address - Fax:919-676-0224
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant