Provider Demographics
NPI:1326372327
Name:DRAKE, REGINA (NP)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 STARLING STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4294
Mailing Address - Country:US
Mailing Address - Phone:912-466-5198
Mailing Address - Fax:912-466-5197
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:SUITE 304
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-466-5198
Practice Address - Fax:912-466-5197
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN061300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBHSPMedicare PIN
GAQ24828Medicare UPIN