Provider Demographics
NPI:1437170172
Name:REGGIE, TINA KADLUBAR
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:KADLUBAR
Last Name:REGGIE
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 1:2021 PLANTATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5266
Mailing Address - Country:US
Mailing Address - Phone:337-478-7152
Mailing Address - Fax:337-478-7104
Practice Address - Street 1:2021 PLANTATION DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5266
Practice Address - Country:US
Practice Address - Phone:337-478-7152
Practice Address - Fax:337-478-7104
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN056642163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse