Provider Demographics
NPI:1366833360
Name:HALL, REGINA L
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:L
Last Name:HALL
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 1:9055 PRESTON PL UNIT 16204
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4165
Mailing Address - Country:US
Mailing Address - Phone:954-682-7325
Mailing Address - Fax:
Practice Address - Street 1:9055 PRESTON PL UNIT 16204
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4165
Practice Address - Country:US
Practice Address - Phone:954-682-7325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171W00000XOther Service ProvidersContractor
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies