Provider Demographics
NPI:1437404639
Name:EWING, REGINA A (PA-C)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:A
Last Name:EWING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 SILVER SANDS CIR
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-8197
Mailing Address - Country:US
Mailing Address - Phone:562-822-1092
Mailing Address - Fax:
Practice Address - Street 1:5844 SILVER SANDS CIR
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-8197
Practice Address - Country:US
Practice Address - Phone:904-966-9034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52247363A00000X
AZ5281363AM0700X
FLPA9106625363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52247OtherCALIFORNIA PA LICENSE
TX1437404639Medicaid
TXPA12239OtherTEXAS PA LICENSE
FLPA9113467OtherFLORIDA PA LICENSED